G0403 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for G0403, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 3 of the 8 states list more than one rate for G0403, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 8 states, 1 publish G0403 per hour, and 7 schedules print no unit at all (a flat amount per service).
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 1 of the 8 states bill G0403 by time.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. Medicare amounts exist for G0403, but no state's Medicaid unit matches Medicare's billing unit closely enough to compute a percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for G0403 run from $4.78 in Kansas to $79.53 in Texas. The two publish it in different units (hour versus no unit printed), so part of that gap is the unit rather than the price. Half the states pay more than the median of $12.88 and half pay less. The usual reasons for a spread like this in IDD services rates:

• Each waiver can carry its own fee schedule, so one state may publish several rates for the same service.
• Waiver rates are usually built from a rate model with assumptions about wages, benefits, training and productive time, and states rebuild those models on different schedules.
• Rates vary with staffing ratio, setting and the person's assessed level of support.

Timing matters too. 5 states set the current rate for G0403 in 2026 or later, while 2 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for G0403 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 8 states.

In 3 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 4 states is not classified yet.

• Plans negotiate; the published rate applies out of network (3 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Texas managed care.

G0403 is a HCPCS Level II professional services code in the IDD services line, billed mostly by providers of waiver services for people with intellectual and developmental disabilities. G codes describe professional services and procedures that have no CPT code, or that payers define more narrowly. Many are timed, so check the unit before comparing.

Modifiers often identify the staffing ratio or support tier, and each carries its own rate. Day services and supported employment are commonly billed in 15-minute units or per day; residential services per day or per month.

Medicare's 2026 physician fee schedule pays $14.17–$17.35 for G0403 (non-facility), depending on the Medicare locality. That is a useful reference point, but Medicare and Medicaid can define the unit differently, so compare only where the units match.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.