H0004 Medicaid reimbursement rates by state
Behavioral health counseling and therapy, per 15 minutes. 23 state Medicaid programs publish a fee-for-service rate for H0004 at the physician psychologist level. Rates run from $10.00 in Louisiana to $210.33 in California, with a median of $23.51.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 23
- Median rate
- $23.51units vary by state
- Highest
- $210.33California
- Medicare (non-facility)
- —not on the physician fee schedule
H0004 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 | 15 min | $841.32 | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $54.60since 2023-10-01 | 15 min | $218.40 | Not classified | — | Rehab Option DHR Fee Schedule |
| IllinoisPhysician or licensed psychologist (incl. BCBA-D) · Illinois Persons with Brain Injury waiver (DHS-DRS Home Services Program, IL.0329) | $50.00since 2026-07-01 | VST | — | Plans must pay at least this | — | HSP Rates and Fees (Medicaid Waiver Serv |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $39.67since 2024-07-01 | 15 min | $158.68 | Plans negotiate; applies out of network | — | OHP FFS behavioral health fee schedule ( |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $33.10since 2026-07-01 | 15 min | $132.40 | Plans must pay at least this | — | Rates for Certain Substance-Related and |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $31.07since 2026-01-01 | 15 min | $124.28 | Plans negotiate; applies out of network | — | HCA Mental health and psychology service |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $27.79since 2020-01-01 | 15 min | $111.16 | Plans negotiate; applies out of network | — | AHCCCS FFS Behavioral Health Outpatient |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $25.56since 2025-07-01 | 15 min | $102.24 | Plans must pay at least this | — | DMAS procedure fee file hcpcmedical.csv |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Problem Gambling Fund (state-funded gambling treatment, claims through the Carelon ASO) | $25.29since 2021-11-01 | 15 min | $101.16 | Not classified | — | FY2022 PBHS Fee Schedule – SUD Gambling_ |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $25.07since 2025-12-01 | 15 min | $100.28 | Not classified | — | SCDHHS RBHS Substance Use Services Fee S |
| KentuckyPhysician or licensed psychologist (incl. BCBA-D) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $24.64since 2026-04-01 | 15 min | $98.56 | Plans negotiate; applies out of network | — | KY Medicaid Behavioral Health fee schedu |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $23.51since 2026-03-01 | 15 min | $94.04 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Outpa |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $22.88since 2022-07-01 | 15 min | $91.52 | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey DDD Community Care Program and Supports Program (IDD waiver services, one rate schedule) | $22.16since 2024-07-01 | 15 min | $88.64 | Paid by the state, outside plans | — | Quick Guide - FY2025 COLA Increases (dat |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $21.78since 2026-07-01 | 15 min | $87.12 | Not classified | — | July 2026 Prenatal Plus and Special Conn |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $21.63since 2023-01-01 | 15 min | $86.52 | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $21.10since 2018-09-01 | 15 min | $84.40 | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $19.03since 2022-07-01 | 15 min | $76.12 | Plans must pay at least this | — | ODMHSAS PICIS 'Rates and Codes for Agenc |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Money Follows the Person (Family Supports track) | $18.56since 2023-07-01 | 15 min | $74.24 | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $16.41since 2008-07-01 | 15 min | $65.64 | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: MHPW SBI |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $11.72since 2022-07-01 | 15 min | $46.88 | Paid by the state, outside plans | — | MO HealthNet fee schedule: Community Psy |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid School Program (school-based services) | $11.25since 2020-06-12 | 15 min | $45.00 | Paid by the state, outside plans | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $10.00since 2026-02-02 | 15 min | $40.00 | Plans must pay at least this | — | Louisiana Medicaid EPSDT Health Services |
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 H0004?
It depends on the state. Of the 23 states with a published fee-for-service rate, the median is $23.51. California pays the most ($210.33 per 15 min) and Louisiana the least ($10.00 per 15 min).
Which state pays the highest Medicaid rate for H0004?
California, at $210.33 per 15 min ($841.32 per hour), effective 2026-07-01.
Do managed-care plans pay the same rate for H0004?
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) · 32 states90832Outpatient psychotherapy and diagnostic evaluation · 32 states90834Outpatient psychotherapy and diagnostic evaluation · 32 states90837Outpatient psychotherapy and diagnostic evaluation · 32 states90847Outpatient psychotherapy and diagnostic evaluation · 32 states90853Outpatient psychotherapy and diagnostic evaluation · 32 states96110Mental health assessment (non-physician) · 32 states96112Mental health assessment (non-physician) · 32 states96130Mental health assessment (non-physician) · 32 states96131Mental health assessment (non-physician) · 32 states96136Mental health assessment (non-physician) · 32 states96137Mental health assessment (non-physician) · 32 states
Track H0004 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.