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L0469 Medicaid reimbursement rates by state

Tlso, sagittal-coronal control. 40 state Medicaid programs publish a fee-for-service rate for L0469 at the physician psychologist level. Rates run from $135.01 in Utah to $539.05 in Hawaii, with a median of $371.78.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
40
Median rate
$371.78units vary by state
Highest
$539.05Hawaii
Medicare (non-facility)
—not on the physician fee schedule

L0469 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.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service$539.05since 2026-06-01——Plans negotiate; applies out of network—Medicaid Fee-For-Service (FFS) Fee Sched
NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules)$538.21since 2019-11-01——Plans negotiate; applies out of network—Provider Type 33, Durable Medical Equipm
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$502.90since 2026-07-01——Plans negotiate; applies out of network—Nebraska Medicaid fee schedule 471-000-5
WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service$489.08since 2021-07-01——Plans negotiate; applies out of network—HCA Prosthetics and orthotics fee schedu
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$478.39since 2019-07-01——Not classified—SCDHHS Durable Medical Equipment (DME) F
KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules)$454.34since 2020-01-01——State sets the plan rate—KY Medicaid DME fee schedule (2020Medica
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$447.41since 2026-07-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$437.00since 2025-06-04——Not classified—Arkansas Medicaid Prosthetics (includes
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$428.47since 2026-01-01——Not classified—Vermont Medicaid Fee Schedule - DME Code
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$425.90since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$421.00since 2014-01-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Durable
IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$419.36since 2018-09-01——Plans must pay at least this—Iowa Medicaid fee schedule #02 PHYSICIAN
Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service)$417.43since 2014-01-01——Plans negotiate; applies out of network—RI Medicaid Interactive Fee For Service
OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA)$405.14since 2014-01-01——Plans negotiate; applies out of network—OHP FFS medical-dental fee schedule (fee
MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service)$390.82since 2026-07-01——Plans must pay at least this—DOM Comprehensive Fee Schedule, Septembe
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$384.93since 2026-01-01——Not classified—MaineCare Section 60, Medical Supplies a
MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service)$384.41since 2019-07-01——Plans negotiate; applies out of network—MO HealthNet fee schedule: Durable Medic
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$384.38since 2022-01-01——Plans must pay at least this—NC Medicaid fee schedule 'Nurse Practiti
LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service)$378.75since 2014-01-01——Plans must pay at least this—Louisiana Medicaid Durable Medical Equip
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$377.39since 2026-01-01——Plans negotiate; applies out of network—MHCP Fee Schedule - Current Fee Schedule
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$366.17since 2023-01-01Each—Plans must pay at least this—DMAS procedure fee file hcpcmedical.csv
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$363.47since 2016-07-01——Plans negotiate; applies out of network—Orthotic and Prosthetic Fee Schedule - E
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$358.63since 2026-01-01——Plans negotiate; applies out of network—MDHHS Medical Suppliers/Orthotists/Prost
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$353.45since 2025-01-01——Plans must pay at least this—New Mexico Medicaid Fee for Service HCPC
PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service)$352.43since 2014-06-23——Plans negotiate; applies out of network—PA DHS PROMISe Outpatient Fee Schedule (
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$350.10since 2019-07-24——Plans negotiate; applies out of network—HFS DME Fee Schedule (effective 2019-07-
MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations)$346.23since 2026-07-01——Plans negotiate; applies out of network—Rates for Prostheses, Prosthetic Devices
DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP)$337.73since 2026-01-01——Plans negotiate; applies out of network—DMAP 2026 DME Fee Schedule
TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP)$327.75since 2014-01-01——Plans negotiate; applies out of network—TMHP Texas Medicaid Fee Schedule - Ortho
New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS)$327.50since 2024-07-01——Not classified—2026 Fee Schedule - Covered Procedures R
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$310.00since 2022-01-01Each—Plans negotiate; applies out of network—ODM DMEPOS combined payment schedules (a
New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service)$306.16since 2022-06-01——Plans negotiate; applies out of network—eMedNY NYS Medicaid DMEPOS Fee Schedule
ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$304.12since 2026-10-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Durable
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$301.91since 2026-07-01——Paid by the state, outside plans—KMAP Fee Schedule MKN Medicaid (FeeSched
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$254.09since 2026-01-01——Plans must pay at least this—SoonerCare Durable Medical Equipment Rat
MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service)$252.68since 2026-01-01——Not classified—Montana Healthcare Programs fee schedule
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$236.41since 2026-07-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP)$204.95since 2026-07-01——Plans negotiate; applies out of network—Child Health Plan Plus FY 2026-2027 Fee
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$194.21since 2026-01-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan)$135.01since 2026-07-01——Plans negotiate; applies out of network—Utah Medicaid Coverage and Reimbursement

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 L0469?

It depends on the state. Of the 40 states with a published fee-for-service rate, the median is $371.78. Hawaii pays the most ($539.05) and Utah the least ($135.01).

Which state pays the highest Medicaid rate for L0469?

Hawaii, at $539.05, effective 2026-06-01.

Do managed-care plans pay the same rate for L0469?

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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