96130 Medicaid reimbursement rates by state
Mental health assessment (non-physician). 25 state Medicaid programs publish a fee-for-service rate for 96130 at the physician psychologist level. Rates run from $46.31 in Texas to $835.49 in California, with a median of $94.19.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 25
- Median rate
- $94.19units vary by state
- Highest
- $835.49California
- Medicare (non-facility)
- $118.95–$147.582026 physician fee schedule
96130 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 |
|---|---|---|---|---|---|---|
| CaliforniaPhysician or licensed psychologist (incl. BCBA-D) · California Medi-Cal Specialty Mental Health Services (DHCS fee schedule for county Mental Health Plans) | $835.49⚠ over 3× mediansince 2026-07-01 | hour | $835.49 | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| NebraskaPhysician or licensed psychologist (incl. BCBA-D) · Nebraska Medicaid (fee-for-service) | $245.54since 2026-07-01 | hour | $245.54 | Plans negotiate; applies out of network | — | Nebraska Medicaid Mental Health and Subs |
| MarylandPhysician or licensed psychologist (incl. BCBA-D) · Maryland Public Behavioral Health System (specialty mental health, SUD and ABA, paid fee-for-service through the Carelon ASO) | $179.37since 2024-07-01 | hour | $179.37 | Paid by the state, outside plans | — | FY2025 PBHS Fee Schedule – Individual Pr |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $132.92since 2022-01-01 | hour | $132.92 | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $129.76since 2026-07-01 | hour | $129.76 | Plans negotiate; applies out of network | — | Child Health Plan Plus Behavioral Health |
| ArizonaPhysician or licensed psychologist (incl. BCBA-D) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $123.31since 2026-10-01 | hour | $123.31 | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $120.35since 2022-07-01 | hour | $120.35 | Plans must pay at least this | — | MO HealthNet fee schedule: Behavioral He |
| MassachusettsPhysician or licensed psychologist (incl. BCBA-D) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $118.24since 2025-09-01 | hour | $118.24 | Plans must pay at least this | — | Rates for Mental Health Services Provide |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $102.44since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $101.75since 2026-07-01 | hour | $101.75 | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $100.88since 2019-01-01 | hour | $100.88 | Plans negotiate; applies out of network | — | Schedule of Maximum Allw Pymt Physician |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $98.33since 2023-10-01 | hour | $98.33 | Plans negotiate; applies out of network | — | eMedNY Clinical Psychology Procedure Cod |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $94.19since 2025-10-01 | hour | $94.19 | Plans must pay at least this | — | NC Medicaid fee schedule 'Physician Serv |
| South CarolinaPhysician or licensed psychologist (incl. BCBA-D) · South Carolina Healthy Connections Medicaid (fee-for-service) | $90.43since 2026-07-01 | hour | $90.43 | Not classified | — | SCDHHS Rehabilitative Behavioral Health |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $88.66since 2021-09-30 | hour | $88.66 | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $87.53since 2020-01-01 | hour | — | Plans negotiate; applies out of network | — | DMS CMHC Mental Health Substance Abuse f |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $80.95since 2026-02-01 | hour | $80.95 | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $79.02since 2026-01-01 | hour | $79.02 | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $78.96since 2025-07-01 | hour | $78.96 | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $77.41since 2026-01-01 | hour | $77.41 | Plans negotiate; applies out of network | — | Practitioner Fee Schedule (2026-01-01) |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $73.76since 2026-07-01 | hour | $73.76 | Plans negotiate; applies out of network | — | HCA Mental health and psychology service |
| OhioAgency provider · Ohio Medicaid (fee-for-service) | $66.82since 2024-01-01 | hour | $66.82 | Plans expected to pay at least this | — | OAC 5160-27-03 Appendix A, Community Beh |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $55.79since 2024-04-01 | hour | $55.79 | Plans negotiate; applies out of network | — | HFS LPHA Fee Schedule (effective 2024-04 |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $52.85since 2026-07-01 | hour | $52.85 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $46.31since 2019-01-01 | hour | $46.31 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
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 96130?
It depends on the state. Of the 25 states with a published fee-for-service rate, the median is $94.19. California pays the most ($835.49 per hour) and Texas the least ($46.31 per hour).
Which state pays the highest Medicaid rate for 96130?
California, at $835.49 per hour ($835.49 per hour), effective 2026-07-01.
Do managed-care plans pay the same rate for 96130?
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 Behavioral health codes
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Track 96130 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.