G0472 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 G0472, 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. 8 of the 21 states list more than one rate for G0472, 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 21 states, 2 publish G0472 per unit, and 19 schedules print no unit at all (a flat amount per service).
• Per hour. G0472 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for G0472, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for G0472 run from $11.09 in Maine to $101.39 in Texas. The two publish it in different units (unit 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 $41.72 and half pay less. The usual reasons for a spread like this in therapy (PT/OT/speech) rates:

• Children's therapy is driven by the EPSDT benefit, so some states maintain separate pediatric rates or programs.
• Visit limits, prior authorization and annual caps vary by state and change how much a single code is worth to a practice.
• States pay therapy by CPT code, but many pay therapy assistants a reduced percentage and some pay differently in outpatient hospital, private practice and home settings.

Timing matters too. 3 states set the current rate for G0472 in 2026 or later, while 9 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.

No managed-care plan publishes what it pays for G0472. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 4 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 12 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 5 states is not classified yet.

• Plans negotiate; the published rate applies out of network (12 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.
• Plans must pay at least the published rate (4 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

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.

G0472 is a HCPCS Level II professional services code in the therapy (PT/OT/speech) line, billed mostly by physical, occupational and speech therapists and therapy practices. 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.

Many treatment codes are timed in 15-minute units, while evaluations and re-evaluations are billed once per session. Medicare applies a rule for counting timed minutes into units; Medicaid programs may follow it or set their own, so check the state's therapy manual.

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.