99245 Medicaid reimbursement rates by state
Outpatient psychotherapy and diagnostic evaluation. 31 state Medicaid programs publish a fee-for-service rate for 99245 at the physician psychologist level. Rates run from $51.00 in Rhode Island to $1,102.73 in California, with a median of $162.16.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 31
- Median rate
- $162.16units vary by state
- Highest
- $1,102.73California
- Medicare (non-facility)
- —not on the physician fee schedule
99245 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) | $1,102.73⚠ over 3× mediansince 2026-07-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $350.61since 2026-07-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - CPT Code |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $300.00since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $250.20since 2024-07-01 | — | — | Not classified | — | CMAP fee schedule: Clinic and Outpatient |
| AlabamaPhysician or licensed psychologist (incl. BCBA-D) · Alabama Coordinated Health Network (primary care case management entities; payments made fee-for-service by the Alabama Medicaid Agency) | $226.00since 2024-10-01 | — | — | Not classified | — | Provider Insider October 2025, 'ACHN Par |
| GeorgiaPhysician or licensed psychologist (incl. BCBA-D) · Georgia Medicaid (fee-for-service) | $223.01since 2020-08-14 | — | — | Plans negotiate; applies out of network | — | Max Allow Pymt Physician Enhanced Rate C |
| 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) | $216.21since 2025-08-01 | — | — | Paid by the state, outside plans | — | FY2027 PBHS Fee Schedule – Individual Pr |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $187.06since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $182.39since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Clinical Pharm |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $179.41since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $177.14since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $169.22since 2025-07-01 | — | — | Plans must pay at least this | — | NJMMIS Procedure Master Listing CPTHCPCS |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $168.36since 2020-03-15 | — | — | Not classified | — | SCDHHS Base Physician Fee Schedule (sche |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $168.06since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $166.18since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2020 |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $162.16since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $161.85since 2023-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $149.03since 2025-02-14 | — | — | Plans negotiate; applies out of network | — | Rates for Vision Care Services and Ophth |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $146.92since 2015-07-01 | — | — | Plans must pay at least this | — | Provider Type 77 Physician's Assistant R |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $142.42since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| PennsylvaniaRegistered nurse (RN) · Pennsylvania Medical Assistance (fee-for-service) | $141.97since 2021-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $138.98since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Practitioner Fee Schedule (2026-01-01) |
| NebraskaPhysician or licensed psychologist (incl. BCBA-D) · Nebraska Medicaid (fee-for-service) | $136.71since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid Mental Health and Subs |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $133.55since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Vision Fee Schedule database, Janu |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $133.24since 2025-05-15 | — | — | Not classified | — | Arkansas Medicaid Oral Surgeon Fee Sched |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $128.89since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $125.17since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Physician-related services fee sched |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid (fee-for-service) | $95.03since 2023-01-01 | unit | — | Plans negotiate; applies out of network | — | eMedNY Physician Fee Schedule Sect 2 (Me |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $94.48since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $90.29since 2019-09-11 | — | — | Plans negotiate; applies out of network | — | HFS Podiatrist Fee Schedule (effective 2 |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $51.00since 2006-05-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
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 99245?
It depends on the state. Of the 31 states with a published fee-for-service rate, the median is $162.16. California pays the most ($1,102.73) and Rhode Island the least ($51.00).
Which state pays the highest Medicaid rate for 99245?
California, at $1,102.73, effective 2026-07-01.
Do managed-care plans pay the same rate for 99245?
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
90791Mental health assessment (non-physician) · 45 states90832Outpatient psychotherapy and diagnostic evaluation · 45 states90834Outpatient psychotherapy and diagnostic evaluation · 45 states90837Outpatient psychotherapy and diagnostic evaluation · 45 states90847Outpatient psychotherapy and diagnostic evaluation · 45 states90853Outpatient psychotherapy and diagnostic evaluation · 45 states96130Mental health assessment (non-physician) · 45 states96131Mental health assessment (non-physician) · 45 states96136Mental health assessment (non-physician) · 45 states96137Mental health assessment (non-physician) · 45 states99202New-patient office visit, level 1 of 4 · 45 states99203New-patient office visit, level 2 of 4 · 45 states
Track 99245 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.