M0243 Medicaid reimbursement rates by state
Intravenous infusion or subcutaneous injection. 11 state Medicaid programs publish a fee-for-service rate for M0243 at the physician psychologist level. Rates run from $34.59 in Texas to $477.00 in New Mexico, with a median of $413.61.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 11
- Median rate
- $413.61units vary by state
- Highest
- $477.00New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
M0243 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 |
|---|---|---|---|---|---|---|
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $477.00since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $450.00since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $450.00since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Nurse Practiti |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $450.00since 2021-05-06 | — | — | Not classified | — | NJMMIS Coronavirus Services procedure co |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $450.00since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2023 |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $413.61since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS COVID-19, January 2021 |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $404.92since 2021-12-08 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid ad hoc COVID-19 fee sc |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $360.00since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | Copy of PADL- Appendix A Published Copy_ |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $360.00since 2021-05-06 | — | — | Plans negotiate; applies out of network | — | 52 Pa.B. 1697 Updates to the Medical Ass |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $309.60since 2020-11-21 | — | — | Not classified | — | COVID-19 Payment Rates for Certain Commu |
| TexasAgency provider · Texas Home Living (TxHmL) waiver (IDD) | $34.59since 2025-09-01 | hour | $34.59 | Paid by the state, outside plans | — | HHSC PFD TxHmL payment rates (9-1-2025-t |
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 M0243?
It depends on the state. Of the 11 states with a published fee-for-service rate, the median is $413.61. New Mexico pays the most ($477.00) and Texas the least ($34.59 per hour).
Which state pays the highest Medicaid rate for M0243?
New Mexico, at $477.00, effective 2025-01-01.
Do managed-care plans pay the same rate for M0243?
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.