H0005 Medicaid reimbursement rates by state
Alcohol and/or drug services. 19 state Medicaid programs publish a fee-for-service rate for H0005 at the physician psychologist level. Rates run from $3.82 in Wisconsin to $58.55 in Oregon, with a median of $15.58.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 19
- Median rate
- $15.58units vary by state
- Highest
- $58.55Oregon
- Medicare (non-facility)
- —not on the physician fee schedule
H0005 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 |
|---|---|---|---|---|---|---|
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $58.55since 2024-07-01 | unit | — | Plans negotiate; applies out of network | — | OHP FFS behavioral health fee schedule ( |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $54.48since 2025-12-01 | — | — | Not classified | — | SCDHHS RBHS Substance Use Services Fee S |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $52.91since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Problem Gambling Fund (state-funded gambling treatment, claims through the Carelon ASO) | $49.32since 2021-11-01 | Per 60-90 minute session | — | Not classified | — | FY2022 PBHS Fee Schedule – SUD Gambling_ |
| CaliforniaPhysician or licensed psychologist (incl. BCBA-D) · California Drug Medi-Cal Organized Delivery System (DHCS county fee schedule / interim rates) | $46.74since 2026-07-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $34.00since 2011-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule (Wayback capture 20250 |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $29.79since 2026-07-01 | — | — | Plans must pay at least this | — | Rates for Certain Substance-Related and |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $27.85since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Outpa |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $23.00since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| ColoradoAny qualified provider (rate does not vary by provider) · Colorado behavioral health services paid fee-for-service by HCPF (outside the RAE capitation) | $15.58since 2026-07-01 | — | — | Paid by the state, outside plans | — | July 2026 Outpatient Substance Abuse Fee |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid Rehabilitation Option (MRO) community mental health services | $14.58since 2010-07-01 | unit | — | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| OhioLicensed mental health clinician (LCSW, LMFT, LPC, licensed practitioner) · Ohio Medicaid (fee-for-service) | $10.56since 2024-01-01 | 15 min | $42.24 | 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) | $10.09since 2025-07-01 | 1/4 hour | — | Plans negotiate; applies out of network | — | HFS Fee Schedule for Substance Use Preve |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $10.00since 2026-02-02 | — | — | Plans must pay at least this | — | Louisiana Medicaid EPSDT Health Services |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $8.84since 2022-07-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $7.72since 2025-07-01 | — | — | Plans must pay at least this | — | DMAS procedure fee file hcpcmedical.csv |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $7.08since 2022-01-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Physician Serv |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $6.89since 2022-07-01 | — | — | Paid by the state, outside plans | — | MO HealthNet fee schedule: Comprehensive |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $3.82since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Mntl Hlt |
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 H0005?
It depends on the state. Of the 19 states with a published fee-for-service rate, the median is $15.58. Oregon pays the most ($58.55 per unit) and Wisconsin the least ($3.82).
Which state pays the highest Medicaid rate for H0005?
Oregon, at $58.55 per unit, effective 2024-07-01.
Do managed-care plans pay the same rate for H0005?
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.
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Track H0005 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.