97813 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 10 state Medicaid programs publish a fee-for-service rate for 97813. Rates run from $19.82 in Illinois to $43.22 in Minnesota, with a median of $24.56.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 10
- Median rate
- $24.56units vary by state
- Highest
- $43.22Minnesota
- Medicare (non-facility)
- $53.85–$71.682026 physician fee schedule
97813 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 |
|---|---|---|---|---|---|---|
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $43.22since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $32.71since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $31.75since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $25.86since 2021-10-01 | — | — | Not classified | — | CMAP fee schedule: Acupuncture Fee Sched |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $24.75since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $24.37since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $21.30since 2024-07-01 | 15 min | $85.20 | Plans negotiate; applies out of network | — | OHP FFS behavioral health fee schedule ( |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $20.00since 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) · Colorado HCBS waiver: Complementary and Integrative Health (CIH, formerly Spinal Cord Injury) | $19.87since 2026-07-01 | 15 min | $79.48 | Paid by the state, outside plans | — | EBD, CMHS, BI, CIH (effective July 1, 20 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $19.82since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Acupuncture Fee Schedule (effective |
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 97813?
It depends on the state. Of the 10 states with a published fee-for-service rate, the median is $24.56. Minnesota pays the most ($43.22) and Illinois the least ($19.82).
Which state pays the highest Medicaid rate for 97813?
Minnesota, at $43.22, effective 2026-02-01.
Do managed-care plans pay the same rate for 97813?
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.