S9494 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: 10 of the 10 states publish S9494 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. 4 of the 10 states list more than one rate for S9494, 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. All 10 states publish S9494 per day, so the amounts compare directly.
• Per hour. S9494 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 S9494, 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 S9494 run from $8.22 in Idaho to $72.79 in Minnesota, a 8.9x gap in the same unit. Half the states pay more than the median of $33.26 per day and half pay less. The usual reasons for a spread like this in other rates:

• Rate studies, settlements and targeted increases for workforce shortages move individual services out of step with the rest of a state's schedule.
• States pay different amounts by provider type, setting and program, and the published rate may already include or exclude add-ons that another state pays separately.
• Some states tie their rates to a percentage of a Medicare amount; others keep a schedule of their own that changes only when the legislature funds an increase.

Timing matters too. 2 states set the current rate for S9494 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.

No managed-care plan publishes what it pays for S9494. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 2 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. The rule for the remaining 3 states is not classified yet.

• Plans negotiate; the published rate applies out of network (5 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.
• The state sets the plan rate (1 state). There is little to negotiate on price. Contracting is about network participation, authorization and billing terms.
• Plans must pay at least the published rate (1 state). 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 Minnesota managed care.

S9494 is a HCPCS Level II temporary national code in the other line, billed mostly by providers. 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.

This service is billed in the unit the state's schedule defines.

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.