S5521 Medicaid reimbursement rates by state
Home infusion therapy, all supplies. 8 state Medicaid programs publish a fee-for-service rate for S5521 at the physician psychologist level. Rates run from $25.75 in Minnesota to $120.79 in Massachusetts, with a median of $82.83.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 8
- Median rate
- $82.83units vary by state
- Highest
- $120.79Massachusetts
- Medicare (non-facility)
- —not on the physician fee schedule
S5521 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 |
|---|---|---|---|---|---|---|
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $120.79since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $116.81since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $110.23since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $85.00since 2026-05-27 | — | — | Not classified | — | DME/POP Fee Schedule (REF-0132-Q) |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $80.65since 2009-01-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $46.64since 2010-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| UtahPhysician or licensed psychologist (incl. BCBA-D) · Utah Medicaid (fee-for-service, Traditional plan) | $45.60since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $25.75since 2012-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
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 S5521?
It depends on the state. Of the 8 states with a published fee-for-service rate, the median is $82.83. Massachusetts pays the most ($120.79) and Minnesota the least ($25.75).
Which state pays the highest Medicaid rate for S5521?
Massachusetts, at $120.79, effective 2026-03-01.
Do managed-care plans pay the same rate for S5521?
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.