96160 Medicaid reimbursement rates by state
SUD case management. 41 state Medicaid programs publish a fee-for-service rate for 96160 at the physician psychologist level. Rates run from $0.01 in Nebraska to $210.33 in California, with a median of $3.03.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 41
- Median rate
- $3.03units vary by state
- Highest
- $210.33California
- Medicare (non-facility)
- $2.59–$4.332026 physician fee schedule
96160 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 |
|---|---|---|---|---|---|---|
| CaliforniaPhysician or licensed psychologist (incl. BCBA-D) · California Drug Medi-Cal Organized Delivery System (DHCS county fee schedule / interim rates) | $210.33⚠ over 3× mediansince 2026-07-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $21.86⚠ over 3× mediansince 2021-01-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $16.88⚠ over 3× mediansince 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Physician Office and |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $14.60⚠ over 3× mediansince 2017-01-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $14.39⚠ over 3× mediansince 2024-09-01 | — | — | Plans must pay at least this | — | 2026 Fee Schedule - Covered Procedures R |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $12.24⚠ over 3× mediansince 2026-07-01 | — | — | Plans must pay at least this | — | HCA EPSDT fee schedule (epsdt-20260701.x |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $8.19since 2024-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| AlabamaPhysician or licensed psychologist (incl. BCBA-D) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $6.23since 2026-09-24 | — | — | Not classified | — | Teaching Facility Fee Schedule |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $4.49since 2025-01-01 | — | — | Plans must pay at least this | — | Fee Schedule for Behavioral Health Provi |
| AlaskaPhysician or licensed psychologist (incl. BCBA-D) · Alaska Medicaid (fee-for-service, Department of Health) | $4.46since 2026-07-01 | — | — | Not classified | — | Alaska Medicaid Physician Fee Schedule S |
| MontanaPhysician or licensed psychologist (incl. BCBA-D) · Montana Medicaid and HMK Plus (fee-for-service) | $4.23since 2026-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $4.01since 2020-09-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $3.95since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Physician Maximum Allowed Fee Schedule - |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $3.74since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Clinical Pharm |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $3.55since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| PennsylvaniaRegistered nurse (RN) · Pennsylvania Medical Assistance (fee-for-service) | $3.48since 2021-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $3.38since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2020 |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $3.34since 2026-06-01 | — | — | Plans must pay at least this | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $3.23since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $3.12since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $3.03since 2017-01-01 | — | — | Plans must pay at least this | — | Provider Type 77 Physician's Assistant R |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $2.91since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2026 Physician Fee Schedule |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $2.90since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid Physician fee sche |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $2.68since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $2.67since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $2.62since 2026-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $2.60since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $2.55since 2026-01-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - CPT Code |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $2.33since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $2.31since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $2.25since 2022-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Thste |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $2.24since 2025-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Professional Services |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $2.22since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $2.14since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $2.01since 2026-01-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $1.95since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | BMS RBRVS 2026 Effective 4/1/26 - 3/31/2 |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $1.92since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $1.53since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | SCDHHS Nurse Midwives Fee Schedule (sche |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $1.33since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid behavioral health programs (CMHC, ACT, BH Link, peer, SUD, health homes; fee-for-service) | $0.01since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $0.01since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
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 96160?
It depends on the state. Of the 41 states with a published fee-for-service rate, the median is $3.03. California pays the most ($210.33) and Nebraska the least ($0.01).
Which state pays the highest Medicaid rate for 96160?
California, at $210.33, effective 2026-07-01.
Do managed-care plans pay the same rate for 96160?
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
90791Mental health assessment (non-physician) · 48 states90832Outpatient psychotherapy and diagnostic evaluation · 48 states90834Outpatient psychotherapy and diagnostic evaluation · 48 states90837Outpatient psychotherapy and diagnostic evaluation · 48 states90847Outpatient psychotherapy and diagnostic evaluation · 48 states90853Outpatient psychotherapy and diagnostic evaluation · 48 states96130Mental health assessment (non-physician) · 48 states96131Mental health assessment (non-physician) · 48 states96136Mental health assessment (non-physician) · 48 states96137Mental health assessment (non-physician) · 48 states99202New-patient office visit, level 1 of 4 · 48 states99203New-patient office visit, level 2 of 4 · 48 states
Track 96160 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.