Q0513 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for Q0513, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. Each state lists a single rate for Q0513.
• Unit. None of the 6 schedules prints a separate unit for Q0513, so each amount is a flat payment for one service as the code defines it.
• Per hour. Q0513 is not billed in time units in these states, so no hourly figure is shown.
• 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 Q0513, 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 Q0513 run from $1.86 in New Hampshire to $33.00 in Kansas, a 17.7x gap in the same unit. Half the states pay more than the median of $27.23 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• Modifiers such as professional or technical component, bilateral, multiple procedure and assistant at surgery change the amount paid, and states apply them with their own percentages.
• Some states pay physician services as a percentage of the Medicare fee schedule; others keep a schedule of their own that may not have been rebased for years.
• Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.

Timing matters too. 2 states set the current rate for Q0513 in 2026 or later, while 3 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 Q0513. 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, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 4 states is not classified yet.

• Plans negotiate; the published rate applies out of network (2 states). 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 Kansas managed care.

Q0513 is a HCPCS Level II temporary code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. Q codes are temporary codes for drugs, biologicals, supplies and services. The unit depends on the code and is often a dose or an item.

Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type. Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead.

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.