S4993 Medicaid reimbursement rates by state
Contraceptive pills for birth control. 17 state Medicaid programs publish a fee-for-service rate for S4993 at the physician psychologist level. Rates run from $0.45 in Illinois to $254.70 in Virginia, with a median of $12.69.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 17
- Median rate
- $12.69units vary by state
- Highest
- $254.70Virginia
- Medicare (non-facility)
- —not on the physician fee schedule
S4993 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 |
|---|---|---|---|---|---|---|
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $254.70⚠ over 3× mediansince 2013-01-01 | — | — | Paid by the state, outside plans | — | DMAS procedure fee file hcpcmedical.csv |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $40.00⚠ over 3× mediansince 2015-01-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $39.59⚠ over 3× mediansince 2024-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2024-2025 Rate |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $28.27since 2017-04-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $28.27since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $23.30since 2018-01-01 | — | — | Plans must pay at least this | — | TMHP Texas Medicaid Fee Schedule - Famil |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $21.00since 2026-07-04 | — | — | Not classified | — | CMAP fee schedule: Clinic - Family Plann |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $18.00since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Family Planning Clinic Fee Schedul |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $12.69since 2013-02-20 | — | — | Plans must pay at least this | — | Louisiana Medicaid Office of Public Heal |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $12.00since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $11.33since 2025-05-01 | — | — | Plans negotiate; applies out of network | — | Rates for Family Planning Services (effe |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $9.31since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Local Health D |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $5.00since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Family planning fee schedule (family |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $4.64since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Preventive fee schedule (202 |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $1.15since 2023-10-01 | — | — | Plans negotiate; applies out of network | — | SCDHHS Nurse Midwives Fee Schedule (sche |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $0.92since 2013-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #22 FAMILY PL |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $0.45since 2012-02-01 | — | — | Plans negotiate; applies out of network | — | HFS School Based Health Services Fee Sch |
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 S4993?
It depends on the state. Of the 17 states with a published fee-for-service rate, the median is $12.69. Virginia pays the most ($254.70) and Illinois the least ($0.45).
Which state pays the highest Medicaid rate for S4993?
Virginia, at $254.70, effective 2013-01-01.
Do managed-care plans pay the same rate for S4993?
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.