Behavioral health Medicaid rates in West Virginia sit below the national median across the ranked services, but the state backs them with clear managed care protections. West Virginia Medicaid pays $75.15 on family therapy code 90846, which ranks 23rd of 28 states and sits 9.8% below the $83.33 national median. Its community rates are lower still.
Yet West Virginia's Mountain Health Trust contracts require plans to pay at least the fee-for-service schedule for behavioral health, and to contract with every CCBHC, and the state's low wages keep its community services above labor cost. Rates are compiled from official West Virginia Medicaid publications, and each rate on the West Virginia Medicaid rates hub links back to its source document.
| Service | Code | WV rate | Rank | vs national median |
|---|---|---|---|---|
| Outpatient psychotherapy and evaluation | 90846 | $75.15 | 23 of 28 | -9.8% |
| Skills training and development | H2014 (HN, U1) | $41.80 an hour | 20 of 33 | -18.4% |
| Therapeutic behavioral services | H2019 | $41.60 an hour | 22 of 28 | -52.6% |
West Virginia also publishes rates on units that are not ranked: counseling on H0004 at $6.93 per 15 minutes, or $27.72 an hour; assessment on T1023 at $75.00 per encounter; service plan development on H0032 at $20.98 per 15 minutes, or $83.92 an hour; and wraparound on T1016 at $449.88 a month. Most date to 2023-04-01; the wraparound rate took effect 2024-10-01. The full dataset holds all 88,707 current West Virginia Medicaid rates, each linked to its source publication.
The 90846 rate of $75.15, effective 2026-04-01, is West Virginia's most recently updated behavioral health rate. It still ranks 23rd of 28. California leads at $302.03 and New Mexico at $144.88; the lowest states are Iowa ($58.46), Pennsylvania ($26.25) and Missouri ($20.33).
The 2026-04-01 date ties the psychotherapy codes to the state's annual RBRVS update, which runs from April to March. The individual session codes, including 90837, share that date and are listed on the state hub. For an outpatient practice, the April update is the one date each year when therapy rates are likely to move.
West Virginia lists no prior authorization rules and no frequency limits on 90791, 90792, 90832, 90833, 90834, 90836, 90837 or 90839, nor on the family and group therapy codes. Low administrative friction partly offsets the below-median rate for outpatient practices.
In practice, a practice can move a client from evaluation to weekly therapy without an approval step in fee-for-service. Mountain Health Trust plans may apply their own utilization review, so a practice contracting with several plans should keep a per-plan list of requirements. Documentation still has to support medical necessity for every session, and a current treatment plan billed under H0032 is the simplest way to keep that record complete when a plan or the state reviews claims.
West Virginia's wages are low, which keeps its community rates workable despite their rank. The state's median psychiatric technician wage is $16.39 an hour, against $21.70 nationally.
- Skills training (H2014). $10.45 per 15 minutes, or $41.80 an hour, since 2023-04-01. Wages take 55.7% of the rate, leaving $18.50 an hour after loaded wages.
- Therapeutic behavioral services (H2019). $10.40 per 15 minutes, or $41.60 an hour, since 2023-04-01. Wages take 56.0% of the rate, leaving $18.30 an hour.
H2019 and H2014 pay almost the same hourly amount in West Virginia, though nationally the H2019 median is much higher. Maine pays $449.72 an hour on H2019 and Wyoming $149.80; Rhode Island pays $139.64 on H2014.
What the thin margin means
A margin of $18.30 to $18.50 an hour after wages has to cover travel, documentation, supervision and overhead. That is workable for agencies that keep visits clustered and documentation efficient, and tight for those serving widely spread rural caseloads. Because the two services pay almost the same, an agency can staff them interchangeably without a revenue penalty.
Counseling on H0004 with modifiers HO and HQ pays $27.72 an hour against a $23.76 median counselor wage. Wages take 121.8% of the rate, so the margin after loaded wages is negative.
The HQ modifier identifies the group setting, where one counselor's hour is spread across several clients. That is how this rate is meant to work. A program delivering individual counseling should use the individual psychotherapy codes, which are paid on the RBRVS schedule, rather than relying on the H0004 group line.
Assessment on T1023 with modifier HE pays $75.00 per encounter, and service plan development on H0032 pays $83.92 an hour. Neither is ranked because of their units, but the planning rate is the strongest hourly figure on West Virginia's community schedule and supports thorough treatment planning.
Wraparound is paid on T1016 with modifiers HA and TF at $449.88 a month, effective 2024-10-01. A monthly rate works like a case rate: the provider earns the same amount whether a family needs a few contacts or many in a given month. Programs should track coordinator hours per family per month to confirm the rate covers the real workload.
West Virginia's May 2025 wages are below the national median for each of these roles:
- Mental health counselor: $23.76, against $28.53 nationally
- Mental health social worker: $24.07, against $28.98
- Clinical psychologist: $37.04, against $48.36
- Nurse practitioner: $61.21, against $63.61
- Psychiatric technician: $16.39, against $21.70
Lower wages are what make West Virginia's below-median community rates viable. A national-median technician at $21.70 an hour would take a much larger share of a $41.60 hourly rate than West Virginia's $16.39 median does, so agencies here can run H2019 and H2014 programs that would struggle at the same rate elsewhere.
West Virginia pays behavioral health through West Virginia Medicaid fee-for-service, run by the Bureau for Medical Services, and through Mountain Health Trust managed care. The plans named in the state data are Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan of West Virginia, UniCare Health Plan of West Virginia and Wellpoint West Virginia; our behavioral health data counts 5 plans. For behavioral health, plans must pay at least the published rate.
The contract terms are what set West Virginia apart:
- SFY2025 contract. Minimum fee schedules for emergency, family planning, DME and behavioral health services were kept at 100% of fee-for-service, effective 2024-07-01.
- SFY2026 contract. The Mountain Health Trust SFY2026 contract renews the minimum fee schedules and directed payments, effective 2025-07-01.
- CCBHCs. Effective 2024-10-01, MCOs must contract with all CCBHCs and pay at or above the state CCBHC fee schedule.
For a West Virginia behavioral health provider, the fee schedule is effectively a floor in plan contracts, and certified community behavioral health clinics have a guaranteed path into every plan network. See the West Virginia managed care page for the full rule set.
West Virginia also runs the Children with Serious Emotional Disorder Waiver (CSEDW) among its Medicaid programs, paid fee-for-service.
- SPA 26-0004. A public notice proposes value-based payments for substance use disorder providers, effective 2027-07-01.
- SPA 25-0002. Approved by CMS, effective 2025-01-01.
- SPA 24-0001. A CCBHC amendment approved by CMS, effective 2024-10-01, the same date as the CCBHC contracting requirement and the T1016 wraparound rate.
- Earlier actions. SPA 22-0013 on community-based mobile crisis services and SPA 22-0011 on targeted case management.
The value-based SUD payment proposal is the change to plan for. Value-based payments typically tie part of a provider's revenue to outcomes or quality measures, so SUD programs should start tracking the measures the final amendment names well before mid-2027.
Virginia, to the east, ranks 2nd in the country on both planning and wraparound, services West Virginia pays on different units, by the 15 minutes and by the month. Comparing them requires converting each to the same basis first, using the service definition and the expected hours per client in each state. Pennsylvania pays less than West Virginia on therapy and skills training. For a provider working across these borders, West Virginia sits in the middle: below-median rates, but lower wages and a firm managed care floor. The Virginia behavioral health page and the Pennsylvania page show the contrast, and national medians are on the behavioral health Medicaid rates by state overview.
- Reload rates each April. The psychotherapy codes follow the annual RBRVS update.
- Use the floor. Mountain Health Trust plans must pay at least the published rate.
- Use the CCBHC path. Certified clinics have guaranteed network access and a rate floor.
- Prepare for value-based SUD payments. SPA 26-0004 is proposed for 2027-07-01.
Plans for the full dataset are on the pricing page.
Rates are compiled from official West Virginia Medicaid publications, including the BMS RBRVS 2026 schedule effective 4/1/26 - 3/31/27. Each rate links to its source document, and West Virginia's history in our data goes back to 2017. Comparison groups match services across codes, hourly figures are converted from the published unit, and ranks include only states with a comparable rate. Wage figures are May 2025 medians. See the methodology page.