S0265 Medicaid reimbursement rates by state
Genetic counseling, under physician supervision. 5 state Medicaid programs publish a fee-for-service rate for S0265. Rates run from $15.00 in California to $67.88 in South Carolina, with a median of $16.12.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $16.12per 15 min
- Highest
- $67.88South Carolina
- Medicare (non-facility)
- —not on the physician fee schedule
S0265 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 |
|---|---|---|---|---|---|---|
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $67.88⚠ over 3× mediansince 2013-01-01 | 15 min | $271.52 | Not classified | — | SCDHHS Pediatric Subspecialty and Neonat |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $21.35since 2026-02-01 | 15 min | $85.40 | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $16.12since 2021-01-01 | 15 min | $64.48 | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $16.11since 2026-07-01 | 15 min | $64.44 | Not classified | — | Health First Colorado Physician Fee Sche |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $15.00since 2026-10-01 | 15 min | $60.00 | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 S0265?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $16.12 per 15 min. South Carolina pays the most ($67.88 per 15 min) and California the least ($15.00 per 15 min).
Which state pays the highest Medicaid rate for S0265?
South Carolina, at $67.88 per 15 min ($271.52 per hour), effective 2013-01-01.
Do managed-care plans pay the same rate for S0265?
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.