Q4205 Medicaid reimbursement rates by state
Membrane graft or membrane wrap, per square centimeter. 12 state Medicaid programs publish a fee-for-service rate for Q4205 at the physician psychologist level. Rates run from $50.55 in Indiana to $1,309.05 in Ohio, with a median of $734.47.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 12
- Median rate
- $734.47units vary by state
- Highest
- $1,309.05Ohio
- Medicare (non-facility)
- $115.04–$183.512026 physician fee schedule
Q4205 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 |
|---|---|---|---|---|---|---|
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $1,309.05since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| MontanaPhysician or licensed psychologist (incl. BCBA-D) · Montana Medicaid and HMK Plus (fee-for-service) | $1,237.28since 2025-10-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $1,237.28since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $1,190.44since 2025-07-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $1,159.61since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $1,159.61since 2025-04-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $309.32since 2025-10-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $127.28since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $127.26since 2026-01-01 | — | — | Not classified | — | South Dakota Medicaid Physician fee sche |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $83.49since 2026-01-01 | — | — | Not classified | — | SCDHHS Pediatric Subspecialty and Neonat |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $81.15since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Oral Maxillofacial Surgeon Fee Sch |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $50.55since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
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 Q4205?
It depends on the state. Of the 12 states with a published fee-for-service rate, the median is $734.47. Ohio pays the most ($1,309.05) and Indiana the least ($50.55 per unit).
Which state pays the highest Medicaid rate for Q4205?
Ohio, at $1,309.05, effective 2024-07-01.
Do managed-care plans pay the same rate for Q4205?
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.