S5190 Medicaid reimbursement rates by state
Wellness assessment, performed by non-physician. 8 state Medicaid programs publish a fee-for-service rate for S5190 at the agency level. Rates run from $6.39 in Nevada to $153.12 in Virginia, with a median of $42.32.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 8
- Median rate
- $42.32units vary by state
- Highest
- $153.12Virginia
- Medicare (non-facility)
- —not on the physician fee schedule
S5190 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 |
|---|---|---|---|---|---|---|
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $153.12since 2026-07-01 | — | — | Plans must pay at least this | — | DMAS procedure fee file hcpcmedical.csv |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Mi Via self-directed 1915(c) Waiver (NM.0448) | $150.61since 2024-10-01 | month | — | Paid by the state, outside plans | — | Mi Via Waiver Fee Schedule - October 1, |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $100.00since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $61.00since 2004-02-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - HCPCS (i |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $23.64since 2026-07-01 | — | — | Paid by the state, outside plans | — | DMAP 2026 CSCRP Fee Schedule |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $13.88since 2003-10-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| WisconsinAgency provider · Wisconsin Children's Long-Term Support (CLTS) Waiver (fee-for-service, statewide uniform rate schedule) | $6.88since 2025-01-01 | 15-min. | — | Paid by the state, outside plans | — | CLTS Waiver Statewide Uniform Rate Sched |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada HCBS Waiver for Individuals with Intellectual and Developmental Disabilities (provider type 38, fee-for-service) | $6.39since 2024-10-01 | 15 min | $25.56 | Paid by the state, outside plans | — | Provider Type 38, Waiver for Individuals |
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 S5190?
It depends on the state. Of the 8 states with a published fee-for-service rate, the median is $42.32. Virginia pays the most ($153.12) and Nevada the least ($6.39 per 15 min).
Which state pays the highest Medicaid rate for S5190?
Virginia, at $153.12, effective 2026-07-01.
Do managed-care plans pay the same rate for S5190?
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.