Billing code S5165 · Other home & community services

S5165 Medicaid reimbursement rate by state (2026)

Home modifications; per service. Medicaid pays a median of $5,000.00 for S5165 across 19 states, from $1.00 in Hawaii to $15,000.00 in South Carolina.

Data as of Oct 5, 202619 statesEvery rate links to its official source

Compare S5165 in all 19 states All billing codes

States publishing: 19
National median: $5,000.00units vary by state
Lowest: $1.00Hawaii
Highest: $15,000.00South Carolina

Answer

What does Medicaid pay for S5165?

19 state Medicaid programs publish a fee-for-service rate for S5165. The national median is $5,000.00 (units differ between states). South Carolina pays the most, $15,000.00 per Lifetime, and Hawaii the least, $1.00 per Per Service Unit, a 15000.0x spread.

State ranking

S5165 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 19 states with every variant, modifier and effective date.

#	State	Medicaid rate	Unit	Per hour	Managed-care plans	% of Medicare
1	South Carolina Source · since 2025-11-01	$15,000.00	Lifetime	—	Paid by the state, outside plans	—
2	South Dakota Source · since 2025-07-01	$15,000.00	month	—	Not classified	—
3	Utah Source · since 2022-01-01	$10,000.00	—	—	Paid by the state, outside plans	—
···
9	Washington Source · since 2023-07-01	$5,000.00	EA	—	Paid by the state, outside plans	—
10	New Jersey Source · since 2025-01-01	$5,000.00	—	—	Not classified	—
11	Montana Source · since 2025-07-01	$4,491.42	—	—	Not classified	—
···
18	Illinois Source · since 2026-01-01	$37.00	month	—	Plans must pay at least this	—
19	Hawaii Source · since 2023-11-01	$1.00	Per Service Unit	—	Paid by the state, outside plans	—

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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; states with several Medicare localities show a range. Confirm rates with the payer before billing.

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FAQ

Frequently asked questions

What does Medicaid pay for S5165?

It depends on the state. Of the 19 states with a published fee-for-service rate, the median is $5,000.00. South Carolina pays the most ($15,000.00 per Lifetime) and Hawaii the least ($1.00 per Per Service Unit).

Which state pays the highest Medicaid rate for S5165?

South Carolina, at $15,000.00 per Lifetime, effective 2025-11-01.

Do managed-care plans pay the same rate for S5165?

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 workspace shows the rule for each state, cited to the contract or statute.

S5165 Medicaid reimbursement rate by state (2026)

What does Medicaid pay for S5165?

S5165 rate by state: highest, middle and lowest

Frequently asked questions

Related codes and states

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