H0005 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 H0005, 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. 19 of the 27 states list more than one rate for H0005, 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 27 states, 4 publish H0005 per 15 min, 2 per unit, 1 per per 60-90 minute session and 1 in other units, and 19 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). 3 of the 27 states bill H0005 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. No Medicare physician fee schedule amount is on file for H0005, 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 H0005 run from $4.10 in District of Columbia to $113.67 in Vermont, a 27.7x gap in the same unit. Half the states pay more than the median of $22.98 and half pay less. The usual reasons for a spread like this in behavioral health rates:

• Community mental health and substance use services are often billed under H and T codes that each state defines for itself, so the same code can describe a different service in two states.
• Behavioral health is frequently run through a separate state agency, a carve-out or a specialty plan, with its own rate-setting cycle.
• States add enhanced rates for crisis services, certified community behavioral health clinics and integrated care that sit outside the base schedule.

Timing matters too. 7 states set the current rate for H0005 in 2026 or later, while 7 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 H0005 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 27 states.

In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 9 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 5 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 6 states is not classified yet.

• Plans negotiate; the published rate applies out of network (9 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 (6 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.
• Paid by the state, outside the plans (5 states). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• Plans are expected to pay at least the published rate (1 state). Treat the published rate as a strong anchor, and confirm the minimum is written into your own plan agreement.

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 Vermont managed care.

H0005 is a HCPCS Level II behavioral health code in the behavioral health line, billed mostly by psychiatrists, psychologists, licensed clinicians and community mental health agencies. H codes were created for state Medicaid agencies to bill mental health and substance use services. Each state defines the unit, which may be 15 minutes, an hour, a day or an episode.

Modifiers such as HO (master's level), HN (bachelor's level) and HP (doctoral level) identify the practitioner, and many states publish a different rate for each. Psychotherapy codes are defined by session length, so one unit is one session of the stated duration; H codes are billed in whatever unit the state defines, often 15 minutes, an hour or a day.

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.