H2025 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 16 of the 19 states publish H2025 per 15 min, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 16 of the 19 states list more than one rate for H2025, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 19 states, 16 publish H2025 per 15 min, 2 per month and 1 per hour.
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 16 of the 19 states bill H2025 by time, with a median of $45.14 per hour.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for H2025, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for H2025 run from $1.38 in Utah to $1,362.84 in Iowa. The two publish it in different units (month versus 15 min), so part of that gap is the unit rather than the price. Half the states pay more than the median of $13.91 and half pay less. The usual reasons for a spread like this in IDD services rates:

• Waiver rates are usually built from a rate model with assumptions about wages, benefits, training and productive time, and states rebuild those models on different schedules.
• Rates vary with staffing ratio, setting and the person's assessed level of support.
• Each waiver can carry its own fee schedule, so one state may publish several rates for the same service.

Timing matters too. 6 states set the current rate for H2025 in 2026 or later, while 4 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

No managed-care plan publishes what it pays for H2025. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 2 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 8 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 7 states is not classified yet.

• Paid by the state, outside the plans (8 states). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• Plans must pay at least the published rate (1 state). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Plans are expected to pay at least the published rate (1 state). Treat the published rate as a strong anchor, and confirm the minimum is written into your own plan agreement.
• Suggested schedule for plans (1 state). Use the schedule as a public benchmark in negotiations; the actual rate is whatever you and the plan agree.
• Plans negotiate; the published rate applies out of network (1 state). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Iowa managed care.

H2025 is a HCPCS Level II behavioral health code in the IDD services line, billed mostly by providers of waiver services for people with intellectual and developmental disabilities. H codes were created for state Medicaid agencies to bill mental health and substance use services. Each state defines the unit, which may be 15 minutes, an hour, a day or an episode.

Modifiers often identify the staffing ratio or support tier, and each carries its own rate. Day services and supported employment are commonly billed in 15-minute units or per day; residential services per day or per month.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.