96138 Medicaid reimbursement rates by state
Mental health assessment (non-physician). 31 state Medicaid programs publish a fee-for-service rate for 96138 at the physician psychologist level. Rates run from $15.06 in New Jersey to $150.70 in California, with a median of $31.09.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 31
- Median rate
- $31.09units vary by state
- Highest
- $150.70California
- Medicare (non-facility)
- $32.57–$54.122026 physician fee schedule
96138 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal Specialty Mental Health Services (DHCS fee schedule for county Mental Health Plans) | $150.70⚠ over 3× mediansince 2026-07-01 | 30 min | $301.40 | Paid by the state, outside plans | 278–366% | Medi-Cal Behavioral Health Fee Schedules |
| NebraskaPhysician or licensed psychologist (incl. BCBA-D) · Nebraska Medicaid (fee-for-service) | $135.41⚠ over 3× mediansince 2026-07-01 | 30 min | $270.82 | Plans negotiate; applies out of network | 391% | Nebraska Medicaid Mental Health and Subs |
| MarylandPhysician or licensed psychologist (incl. BCBA-D) · Maryland Public Behavioral Health System (specialty mental health, SUD and ABA, paid fee-for-service through the Carelon ASO) | $61.59since 2024-07-01 | 30 min | $123.18 | Paid by the state, outside plans | 152–161% | FY2025 PBHS Fee Schedule – Individual Pr |
| MontanaPhysician or licensed psychologist (incl. BCBA-D) · Montana Medicaid and HMK Plus (fee-for-service) | $53.05since 2026-07-01 | 30 min | $106.10 | Not classified | 141% | Montana Healthcare Programs fee schedule |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $46.07since 2025-01-01 | 30 min | $92.14 | Plans must pay at least this | 133% | Fee Schedule for Behavioral Health Provi |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $42.58since 2022-01-01 | 30 min | $85.16 | Plans negotiate; applies out of network | 118% | ForwardHealth max fee schedule: Medical- |
| MassachusettsPhysician or licensed psychologist (incl. BCBA-D) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $41.53since 2025-09-01 | 30 min | $83.06 | Plans must pay at least this | — | Rates for Mental Health Services Provide |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $38.58since 2026-07-01 | 30 min | $77.16 | Plans negotiate; applies out of network | 104% | DMAS procedure fee file cptmedical4.csv |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $37.84since 2026-10-01 | 30 min | $75.68 | Plans negotiate; applies out of network | 104% | AHCCCS Arizona Health Care Cost Containm |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $34.42since 2022-07-01 | 30 min | $68.84 | Plans must pay at least this | 96–106% | MO HealthNet fee schedule: Behavioral He |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $33.41since 2019-01-01 | 30 min | $66.82 | Plans must pay at least this | 89% | Provider Type 26 Psychologist Reimbursem |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $32.88since 2019-07-01 | 30 min | $65.76 | Plans negotiate; applies out of network | 86–97% | Schedule of Maximum Allw Pymt Physician |
| MinnesotaPhysician or licensed psychologist (incl. BCBA-D) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $31.88since 2026-05-21 | 30 min | $63.76 | Plans must pay at least this | 83% | MH Procedure CPT or HCPC Codes and Rates |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $31.76since 2026-07-01 | 30 min | $63.52 | Plans negotiate; applies out of network | 79% | Child Health Plan Plus Behavioral Health |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $31.35since 2023-10-01 | 30 min | $62.70 | Plans negotiate; applies out of network | 70–88% | eMedNY Physician Fee Schedule Sect 2 (Me |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $31.09since 2025-10-01 | 30 min | $62.18 | Plans must pay at least this | 89% | NC Medicaid fee schedule 'Nurse Practiti |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $31.09since 2019-01-01 | 30 min | $62.18 | Plans must pay at least this | — | ODMHSAS PICIS 'Rates and Codes for Agenc |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $30.88since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $30.76since 2019-01-01 | 30 min | $61.52 | Plans must pay at least this | 90% | Iowa Medicaid fee schedule #02 PHYSICIAN |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $30.74since 2026-01-01 | 30 min | $61.48 | Plans negotiate; applies out of network | 74–82% | OHA Administrative Examinations and Repo |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $30.44since 2024-08-01 | 30 min | $60.88 | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $29.87since 2026-07-01 | 30 min | $59.74 | Not classified | 86% | Idaho Medicaid Numerical Fee Schedule Ju |
| South CarolinaPhysician or licensed psychologist (incl. BCBA-D) · South Carolina Healthy Connections Medicaid (fee-for-service) | $29.68since 2025-12-01 | 30 min | $59.36 | Not classified | — | SCDHHS RBHS Substance Use Services Fee S |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $28.66since 2026-01-01 | 30 min | $57.32 | Not classified | 70% | CMAP fee schedule: Physician Office and |
| AlabamaPhysician or licensed psychologist (incl. BCBA-D) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $25.88since 2025-12-01 | 30 min | $51.76 | Not classified | 79% | Behavior Health Services Fee Schedule |
| KentuckyPhysician or licensed psychologist (incl. BCBA-D) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $25.17since 2026-04-01 | 30 min | $50.34 | Plans negotiate; applies out of network | 75% | KY Medicaid Behavioral Health fee schedu |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $25.06since 2026-01-01 | 30 min | $50.12 | Not classified | 67–72% | MaineCare Fee Schedule (MaineCare UCR, H |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $24.07since 2026-01-01 | 30 min | $48.14 | Plans negotiate; applies out of network | 66–70% | MDHHS Child and Adolescent Health Center |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $23.70since 2026-07-01 | 30 min | $47.40 | Plans negotiate; applies out of network | 51–60% | HCA Mental health and psychology service |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $20.56since 2025-07-01 | 30 min | $41.12 | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $15.06since 2024-06-01 | 30 min | $30.12 | Not classified | 34–37% | NJMMIS Procedure Master Listing CPTHCPCS |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 96138?
It depends on the state. Of the 31 states with a published fee-for-service rate, the median is $31.09. California pays the most ($150.70 per 30 min) and New Jersey the least ($15.06 per 30 min).
Which state pays the highest Medicaid rate for 96138?
California, at $150.70 per 30 min ($301.40 per hour), effective 2026-07-01.
How do Medicaid rates for 96138 compare with Medicare?
Where the billing units match, Medicaid pays between 36% and 391% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 96138?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
Related Behavioral health codes
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Track 96138 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.