L0469 Medicaid reimbursement rates by state
Tlso, sagittal-coronal control. 37 state Medicaid programs publish a fee-for-service rate for L0469 at the physician psychologist level. Rates run from $135.01 in Utah to $538.21 in Nevada, with a median of $366.17.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 37
- Median rate
- $366.17units vary by state
- Highest
- $538.21Nevada
- 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.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| 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 |
| 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 2023-01-01 | Each | — | 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 |
| 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 2022-01-01 | Each | — | 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 2026-01-01 | unit | — | 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 37 states with a published fee-for-service rate, the median is $366.17. Nevada pays the most ($538.21) and Utah the least ($135.01).
Which state pays the highest Medicaid rate for L0469?
Nevada, at $538.21, effective 2019-11-01.
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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Track L0469 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.