S9480 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 21 of the 23 states publish S9480 per day, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 17 of the 23 states list more than one rate for S9480, 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 23 states, 21 publish S9480 per day and 1 per hour, and 1 schedule prints no unit at all (a flat amount per service).
• Per hour. S9480 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 S9480, 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 S9480 run from $17.62 in Illinois to $820.80 in New Jersey. The two publish it in different units (day versus 1 hr), so part of that gap is the unit rather than the price. Half the states pay more than the median of $152.29 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• 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.
• Some states pay physician services as a percentage of the Medicare fee schedule; others keep a schedule of their own that may not have been rebased for years.
• Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.

Timing matters too. 7 states set the current rate for S9480 in 2026 or later, while 3 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 S9480 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 23 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 1 state, 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 (7 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 (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.

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 New Jersey managed care.

S9480 is a HCPCS Level II temporary national code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. S codes were created for private payers and are widely used by Medicaid programs for services Medicare does not cover, such as home nursing and home infusion. Units range from 15 minutes to a day.

Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity. Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type.

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.