99451 Medicaid reimbursement rates by state
SUD case management. 21 state Medicaid programs publish a fee-for-service rate for 99451 at the physician psychologist level. Rates run from $17.58 in Washington to $498.90 in California, with a median of $28.24.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 21
- Median rate
- $28.24units vary by state
- Highest
- $498.90California
- Medicare (non-facility)
- $33.57–$41.782026 physician fee schedule
99451 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 in State Plan (non-ODS) counties | $498.90⚠ over 3× mediansince 2026-07-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| PennsylvaniaRegistered nurse (RN) · Pennsylvania Medical Assistance (fee-for-service) | $42.30since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $37.60since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $34.30since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $33.13since 2024-07-01 | — | — | Not classified | — | SCDHHS Enhanced Physician Fee Schedule ( |
| ArizonaPhysician or licensed psychologist (incl. BCBA-D) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $32.00since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $31.83since 2019-01-01 | — | — | Plans negotiate; applies out of network | — | Schedule of Maximum Allw Pymt Physician |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $29.80since 2024-04-15 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Behavioral He |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $28.62since 2020-09-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $28.46since 2024-04-01 | unit | — | Plans negotiate; applies out of network | — | eMedNY Physician Fee Schedule Sect 2 (Me |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $28.24since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'ACA Physician |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $27.12since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $26.24since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $25.58since 2024-01-01 | — | — | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| IllinoisPhysician or licensed psychologist (incl. BCBA-D) · Illinois Medicaid (HFS fee-for-service) | $23.69since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | CY 2025 Access Rule Comparative Analysis |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $23.00since 2026-07-01 | — | — | Plans must pay at least this | — | NJMMIS Procedure Master Listing CPTHCPCS |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $22.58since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Certified Nurse Midwife Fee Schedu |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $22.56since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $21.75since 2026-01-01 | visit | — | Plans negotiate; applies out of network | 64% | KY Medicaid OT fee schedule (2026Occupat |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $21.68since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $17.58since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Physician-related services fee sched |
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 99451?
It depends on the state. Of the 21 states with a published fee-for-service rate, the median is $28.24. California pays the most ($498.90) and Washington the least ($17.58).
Which state pays the highest Medicaid rate for 99451?
California, at $498.90, effective 2026-07-01.
How do Medicaid rates for 99451 compare with Medicare?
Where the billing units match, Medicaid pays between 64% and 64% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 99451?
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.