0520T Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 7 state Medicaid programs publish a fee-for-service rate for 0520T. Rates run from $116.81 in Iowa to $29,878.33 in Rhode Island, with a median of $4,970.91.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $4,970.91units vary by state
- Highest
- $29,878.33Rhode Island
- Medicare (non-facility)
- —not on the physician fee schedule
0520T 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 |
|---|---|---|---|---|---|---|
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $29,878.33⚠ over 3× mediansince 2026-07-01 | — | — | Plans negotiate; applies out of network | — | RI APC (Outpatient) Fee Schedule, as of |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $21,996.46⚠ over 3× mediansince 2019-01-01 | — | — | Plans must pay at least this | — | OPPS Codes (NM Medicaid Hospital Outpati |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $7,492.45since 2026-01-01 | — | — | Not classified | — | Arkansas Medicaid CY2026 Ambulatory Surg |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $4,970.91since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2026 ASC Fee Schedule |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $4,108.24since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $116.81since 2026-01-01 | — | — | Not classified | — | CMAP Addendum B - OPPS Payment Type by P |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $116.81since 2026-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid Addendum B (CY 26-Janaury) |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 0520T?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $4,970.91. Rhode Island pays the most ($29,878.33) and Iowa the least ($116.81).
Which state pays the highest Medicaid rate for 0520T?
Rhode Island, at $29,878.33, effective 2026-07-01.
Do managed-care plans pay the same rate for 0520T?
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.