M0249 Medicaid reimbursement rates by state
Intravenous infusion, tocilizumab. 25 state Medicaid programs publish a fee-for-service rate for M0249 at the physician psychologist level. Rates run from $54.03 in Texas to $571.95 in Alaska, with a median of $450.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 25
- Median rate
- $450.00units vary by state
- Highest
- $571.95Alaska
- Medicare (non-facility)
- —not on the physician fee schedule
M0249 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 |
|---|---|---|---|---|---|---|
| AlaskaPhysician or licensed psychologist (incl. BCBA-D) · Alaska Medicaid (fee-for-service, Department of Health) | $571.95since 2026-07-01 | — | — | Not classified | — | Alaska Medicaid Physician Fee Schedule S |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $455.67since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $450.00since 2021-06-24 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $450.00since 2021-06-24 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service) | $450.00since 2021-06-24 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $450.00since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $450.00since 2021-06-24 | — | — | Not classified | — | COVID-19 Payment Rates for Certain Commu |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $450.00since 2021-06-24 | — | — | Not classified | — | NJMMIS Coronavirus Services procedure co |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $450.00since 2021-06-24 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $450.00since 2021-06-24 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Practitioner |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $450.00since 2021-06-24 | — | — | Not classified | — | COVID-19 Reimbursable Vaccine and Infusi |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $450.00since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2023 |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $450.00since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Nurse Practitioner Fee |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $450.00since 2021-06-24 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $450.00since 2022-04-01 | — | — | Not classified | — | South Dakota Medicaid Drugs and Biologic |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $432.00since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $427.50since 2026-01-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - HCPCS (i |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $418.50since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid ad hoc fee schedule: C |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $403.66since 2021-06-24 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $372.20since 2023-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $360.00since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | Copy of PADL- Appendix A Published Copy_ |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $348.61since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $308.86since 2026-01-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $112.50since 2021-06-24 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| TexasAgency provider · Texas Home and Community-based Services (HCS) waiver (IDD) | $54.03since 2024-09-01 | one time | — | Paid by the state, outside plans | — | HHSC PFD HCS payment rates (09-2024-hcs- |
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 M0249?
It depends on the state. Of the 25 states with a published fee-for-service rate, the median is $450.00. Alaska pays the most ($571.95) and Texas the least ($54.03 per one time).
Which state pays the highest Medicaid rate for M0249?
Alaska, at $571.95, effective 2026-07-01.
Do managed-care plans pay the same rate for M0249?
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.
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Track M0249 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.