96137 Medicaid reimbursement rates by state
Mental health assessment (non-physician). 25 state Medicaid programs publish a fee-for-service rate for 96137 at the physician psychologist level. Rates run from $8.66 in New Jersey to $412.94 in California, with a median of $30.42.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 25
- Median rate
- $30.42units vary by state
- Highest
- $412.94California
- Medicare (non-facility)
- $34.08–$48.362026 physician fee schedule
96137 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) | $412.94⚠ over 3× mediansince 2026-07-01 | 30 min | $825.88 | Paid by the state, outside plans | 854–1048% | Medi-Cal Behavioral Health Fee Schedules |
| 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) | $68.96since 2024-07-01 | 30 min | $137.92 | Paid by the state, outside plans | 177–184% | FY2025 PBHS Fee Schedule – Individual Pr |
| NebraskaPhysician or licensed psychologist (incl. BCBA-D) · Nebraska Medicaid (fee-for-service) | $63.19since 2026-07-01 | 30 min | $126.38 | Plans negotiate; applies out of network | 179% | Nebraska Medicaid Mental Health and Subs |
| MassachusettsPhysician or licensed psychologist (incl. BCBA-D) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $50.27since 2025-09-01 | 30 min | $100.54 | Plans must pay at least this | — | Rates for Mental Health Services Provide |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $49.11since 2022-01-01 | 30 min | $98.22 | Plans negotiate; applies out of network | 136% | ForwardHealth max fee schedule: Medical- |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $48.84since 2026-07-01 | 30 min | $97.68 | Plans negotiate; applies out of network | 126% | Child Health Plan Plus Behavioral Health |
| South CarolinaPhysician or licensed psychologist (incl. BCBA-D) · South Carolina Healthy Connections Medicaid (fee-for-service) | $45.21since 2026-07-01 | 30 min | $90.42 | Not classified | — | SCDHHS Rehabilitative Behavioral Health |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $39.84since 2022-07-01 | 30 min | $79.68 | Plans must pay at least this | 111–117% | MO HealthNet fee schedule: Behavioral He |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $37.51since 2019-01-01 | 30 min | $75.02 | Plans negotiate; applies out of network | 100–108% | Schedule of Maximum Allw Pymt Physician |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $33.35since 2023-10-01 | 30 min | $66.70 | Plans negotiate; applies out of network | 79–93% | eMedNY Clinical Psychology Procedure Cod |
| OhioAgency provider · Ohio Medicaid (fee-for-service) | $32.01since 2024-01-01 | Additional 30 Minutes | — | Plans expected to pay at least this | — | OAC 5160-27-03 Appendix A, Community Beh |
| MinnesotaPhysician or licensed psychologist (incl. BCBA-D) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $31.05since 2026-05-21 | 30 min | $62.10 | Plans must pay at least this | 82% | MH Procedure CPT or HCPC Codes and Rates |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $30.42since 2024-08-01 | 30 min | $60.84 | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| KentuckyPhysician or licensed psychologist (incl. BCBA-D) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $27.93since 2023-07-01 | 30 min | $55.86 | Plans negotiate; applies out of network | 81% | KY Medicaid Behavioral Health fee schedu |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $23.64since 2025-01-01 | 30 min | $47.28 | Plans negotiate; applies out of network | 65–67% | MDHHS Child and Adolescent Health Center |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $22.74since 2026-07-01 | 30 min | $45.48 | Plans negotiate; applies out of network | 53–59% | HCA Mental health and psychology service |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $21.33since 2019-05-15 | 30 min | $42.66 | Plans negotiate; applies out of network | 56–61% | HFS Licensed Clinical Psychologists and |
| ArizonaPhysician or licensed psychologist (incl. BCBA-D) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $20.41since 2026-10-01 | 30 min | $40.82 | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $16.83since 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) | $16.73since 2026-07-01 | 30 min | $33.46 | Plans negotiate; applies out of network | 46% | DMAS procedure fee file cptmedical4.csv |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $16.71since 2020-03-10 | 30 min | $33.42 | Plans must pay at least this | 47% | NC Medicaid fee schedule 'Local Health D |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $15.73since 2020-12-21 | 30 min | $31.46 | Plans negotiate; applies out of network | 41–45% | PA DHS PROMISe Outpatient Fee Schedule ( |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $14.88since 2024-03-01 | 30 min | $29.76 | Plans negotiate; applies out of network | 39–42% | TMHP Texas Medicaid Fee Schedule - Physi |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $12.73since 2026-01-01 | 30 min | $25.46 | Plans negotiate; applies out of network | 34–35% | Practitioner Fee Schedule (2026-01-01) |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $8.66since 2024-06-01 | 30 min | $17.32 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
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 96137?
It depends on the state. Of the 25 states with a published fee-for-service rate, the median is $30.42. California pays the most ($412.94 per 30 min) and New Jersey the least ($8.66 per 30 min).
Which state pays the highest Medicaid rate for 96137?
California, at $412.94 per 30 min ($825.88 per hour), effective 2026-07-01.
How do Medicaid rates for 96137 compare with Medicare?
Where the billing units match, Medicaid pays between 35% and 951% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 96137?
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 96137 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.