S9485 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: 19 of the 25 states publish S9485 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. 22 of the 25 states list more than one rate for S9485, 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 25 states, 19 publish S9485 per day, 3 per encounter and 2 per unit, and 1 schedule prints no unit at all (a flat amount per service).
• Per hour. S9485 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 S9485, 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 S9485 run from $142.14 in Kansas to $1,804.61 in New Mexico. The two publish it in different units (encounter versus day), so part of that gap is the unit rather than the price. Half the states pay more than the median of $487.79 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.
• Many states pay behavioral health services differently by the practitioner's credential, from psychiatrist and psychologist to licensed clinical social worker, counselor and peer specialist.
• States add enhanced rates for crisis services, certified community behavioral health clinics and integrated care that sit outside the base schedule.

Timing matters too. 6 states set the current rate for S9485 in 2026 or later, while 5 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 S9485 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 25 states.

In 10 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 5 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 3 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 7 states is not classified yet.

• Plans must pay at least the published rate (9 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.
• Plans negotiate; the published rate applies out of network (4 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.
• Paid by the state, outside the plans (3 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.
• Suggested schedule for plans (1 state). Use the schedule as a public benchmark in negotiations; the actual rate is whatever you and the plan agree.

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 Mexico managed care.

S9485 is a HCPCS Level II temporary national code in the behavioral health line, billed mostly by psychiatrists, psychologists, licensed clinicians and community mental health agencies. 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.

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. 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.

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.