H0038 Medicaid reimbursement rates by state
Self-help/peer services, per 15 minutes. 29 state Medicaid programs publish a fee-for-service rate for H0038 at the physician psychologist level. Rates run from $1.22 in Texas to $86.64 in California, with a median of $10.52.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 29
- Median rate
- $10.52units vary by state
- Highest
- $86.64California
- Medicare (non-facility)
- —not on the physician fee schedule
H0038 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 |
|---|---|---|---|---|---|---|
| CaliforniaAny qualified provider (rate does not vary by provider) · California Drug Medi-Cal in State Plan (non-ODS) counties | $86.64⚠ over 3× mediansince 2026-07-01 | 15 min | $346.56 | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $55.00⚠ over 3× mediansince 2025-01-01 | 15 min | $220.00 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $39.84since 2024-08-01 | 1/4 hr | — | Plans negotiate; applies out of network | — | HFS Community Based Behavioral Services |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia developmental disability waivers (Building Independence, Family and Individual Supports, Community Living) | $35.00since 2026-07-01 | hour | $35.00 | Paid by the state, outside plans | — | DMAS Developmental Disabilities Waiver S |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $28.91since 2025-09-01 | 15 min | $115.64 | Plans must pay at least this | — | Rates for Certain Children’s Behavioral |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $26.49since 2024-07-01 | 15 min | $105.96 | Plans negotiate; applies out of network | — | OHP FFS behavioral health fee schedule ( |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $22.15since 2022-07-01 | 15 min | $88.60 | Paid by the state, outside plans | — | MO HealthNet fee schedule: Comprehensive |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Public Behavioral Health System (specialty mental health, SUD and ABA, paid fee-for-service through the Carelon ASO) | $18.77since 2024-07-01 | 15 min | $75.08 | Paid by the state, outside plans | — | FY2025 PBHS Fee Schedule – SUD_7.1.2024 |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $15.04since 2025-10-01 | 15 min | $60.16 | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Enhanced Menta |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $15.02since 2026-05-21 | 15 min | $60.08 | Plans must pass increases through | — | MH Procedure CPT or HCPC Codes and Rates |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $15.01since 2024-01-01 | 15 min | $60.04 | Plans negotiate; applies out of network | — | HCA Specialized mental health fee schedu |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Mental Health Waiver (WISE, DMHAS-operated 1915(c)) | $13.02since 2021-07-01 | 15 min | $52.08 | Not classified | — | CMAP fee schedule: Mental Health Waiver |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $12.65since 2026-01-01 | 15 min | $50.60 | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $11.43since 2025-01-01 | 15 min | $45.72 | Plans must pay at least this | — | Fee Schedule for Behavioral Health Provi |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $10.52since 2026-07-01 | 15 min | $42.08 | Plans negotiate; applies out of network | — | Nebraska Medicaid Mental Health and Subs |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $10.00since 2021-09-30 | 15 min | $40.00 | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $9.07since 2024-07-01 | 15 min | $36.28 | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, June 202 |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $8.61since 2020-01-01 | 15 min | — | Plans negotiate; applies out of network | — | DMS CMHC Mental Health Substance Abuse f |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $8.39since 2022-10-12 | 15 min | $33.56 | Not classified | — | Arkansas Medicaid Adult Behavioral Healt |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $8.01since 2022-07-01 | 15 min | $32.04 | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $7.56since 2026-07-01 | 15 min | $30.24 | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $5.79since 2026-10-01 | 15 min | $23.16 | Plans negotiate; applies out of network | — | AHCCCS FFS Fee Schedule Final FFS Behavi |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $4.65since 2025-07-01 | 15 min | $18.60 | Not classified | — | Rehab Option MI Fee Schedule |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $3.23since 2024-01-01 | 15 min. | — | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $3.00since 2025-01-01 | 15 min | $12.00 | Plans must pay at least this | — | Provider Type 26 Psychologist Reimbursem |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Children's Long-Term Support (CLTS) Waiver (fee-for-service, statewide uniform rate schedule) | $2.71since 2025-01-01 | 15-min. | — | Paid by the state, outside plans | — | CLTS Waiver Statewide Uniform Rate Sched |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $2.61since 2026-07-01 | 15 min | $10.44 | Not classified | — | SCDHHS Rehabilitative Behavioral Health |
| OhioAgency provider · Ohio Medicaid (fee-for-service) | $2.19since 2024-01-01 | 15 min | $8.76 | Plans expected to pay at least this | — | OAC 5160-27-03 Appendix A, Community Beh |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $1.22since 2026-03-01 | 15 min | $4.88 | 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 H0038?
It depends on the state. Of the 29 states with a published fee-for-service rate, the median is $10.52. California pays the most ($86.64 per 15 min) and Texas the least ($1.22 per 15 min).
Which state pays the highest Medicaid rate for H0038?
California, at $86.64 per 15 min ($346.56 per hour), effective 2026-07-01.
Do managed-care plans pay the same rate for H0038?
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 H0038 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.