M0224 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 M0224, 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. 4 of the 19 states list more than one rate for M0224, 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 19 states, 1 publish M0224 per unit, and 18 schedules print no unit at all (a flat amount per service).
• Per hour. M0224 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 M0224, 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 M0224 run from $303.75 in Missouri to $472.50 in Hawaii, a 1.6x gap in the same unit. Half the states pay more than the median of $450.00 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• Each state sets its own physician conversion factor or fee for every code, and many update them on a state budget cycle rather than on Medicare's calendar.
• Primary-care and pediatric add-ons, enhanced rates for certain specialties and targeted increases for access problems change individual codes without moving the rest of the schedule.
• Modifiers such as professional or technical component, bilateral, multiple procedure and assistant at surgery change the amount paid, and states apply them with their own percentages.

Timing matters too. 4 states set the current rate for M0224 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For M0224, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 4 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 8 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 7 states is not classified yet.

• Plans negotiate; the published rate applies out of network (8 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 Hawaii managed care.

M0224 is a billing code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. This code is billed per service as the state's schedule defines it.

Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity. Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead.

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.