31243 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 23 state Medicaid programs publish a fee-for-service rate for 31243 at the physician psychologist level. Rates run from $67.86 in New Jersey to $3,377.43 in Alabama, with a median of $541.33.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 23
- Median rate
- $541.33units vary by state
- Highest
- $3,377.43Alabama
- Medicare (non-facility)
- $2,005.97–$3,313.182026 physician fee schedule
31243 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 |
|---|---|---|---|---|---|---|
| AlabamaPhysician or licensed psychologist (incl. BCBA-D) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $3,377.43since 2026-09-24 | — | — | Not classified | — | Teaching Facility Fee Schedule |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $3,267.21since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $2,029.41since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,961.43since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $1,906.66since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2024 |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $1,904.84since 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Physician Surgical 04 |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $1,902.57since 2024-01-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Professional Services |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $1,813.30since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $1,706.29since 2024-01-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Practitioner |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $1,483.33since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $1,241.33since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | SCDHHS Nurse Midwives Fee Schedule (sche |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $541.33since 2024-01-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $411.24since 2025-05-15 | — | — | Not classified | — | Arkansas Medicaid Oral Surgeon Fee Sched |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $370.50since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $166.43since 2024-01-01 | — | — | Plans must pay at least this | — | Provider Type 20 Physician, MD., Osteopa |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $139.86since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $134.22since 2024-01-01 | unit | — | Plans negotiate; applies out of network | — | eMedNY Physician Fee Schedule Sect 5 (Su |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $131.88since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Max Allow Payment_OutP Site of Service J |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $120.21since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $117.20since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $116.90since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical2.csv |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $108.50since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $67.86since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
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 31243?
It depends on the state. Of the 23 states with a published fee-for-service rate, the median is $541.33. Alabama pays the most ($3,377.43) and New Jersey the least ($67.86).
Which state pays the highest Medicaid rate for 31243?
Alabama, at $3,377.43, effective 2026-09-24.
Do managed-care plans pay the same rate for 31243?
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.
Related Physician & professional codes
10005Physician and practitioner services (fee schedule) · 35 states10006Physician and practitioner services (fee schedule) · 35 states10007Physician and practitioner services (fee schedule) · 35 states10008Physician and practitioner services (fee schedule) · 35 states10009Physician and practitioner services (fee schedule) · 35 states10010Physician and practitioner services (fee schedule) · 35 states10021Physician and practitioner services (fee schedule) · 35 states10030Physician and practitioner services (fee schedule) · 35 states10060Physician and practitioner services (fee schedule) · 35 states10061Physician and practitioner services (fee schedule) · 35 states10080Physician and practitioner services (fee schedule) · 35 states10081Physician and practitioner services (fee schedule) · 35 states
Track 31243 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.