96003 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 5 state Medicaid programs publish a fee-for-service rate for 96003. Rates run from $10.44 in Michigan to $23.65 in New Mexico, with a median of $16.07.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $16.07units vary by state
- Highest
- $23.65New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
96003 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) | $23.65since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $17.41since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $16.07since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2024-2025 Rate |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $12.21since 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) | $10.44since 2023-10-01 | — | — | 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 96003?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $16.07. New Mexico pays the most ($23.65) and Michigan the least ($10.44).
Which state pays the highest Medicaid rate for 96003?
New Mexico, at $23.65, effective 2025-01-01.
Do managed-care plans pay the same rate for 96003?
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.