54438 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 5 state Medicaid programs publish a fee-for-service rate for 54438. Rates run from $846.68 in Michigan to $1,921.97 in New Mexico, with a median of $1,147.21.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $1,147.21units vary by state
- Highest
- $1,921.97New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
54438 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 |
|---|---|---|---|---|---|---|
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $1,921.97since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $1,192.17since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Physician Maximum Allowed Fee Schedule - |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,147.21since 2025-10-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $976.65since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $846.68since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
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 54438?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $1,147.21. New Mexico pays the most ($1,921.97) and Michigan the least ($846.68).
Which state pays the highest Medicaid rate for 54438?
New Mexico, at $1,921.97, effective 2025-01-01.
Do managed-care plans pay the same rate for 54438?
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.