V5221 Medicaid reimbursement rates by state
Hearing aid, contralateral routing system, binaural, bte/bte. 20 state Medicaid programs publish a fee-for-service rate for V5221 at the physician psychologist level. Rates run from $0.00 in Arkansas to $2,158.00 in Georgia, with a median of $762.33.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 20
- Median rate
- $762.33units vary by state
- Highest
- $2,158.00Georgia
- Medicare (non-facility)
- —not on the physician fee schedule
V5221 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 |
|---|---|---|---|---|---|---|
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $2,158.00since 2019-10-01 | — | — | Plans negotiate; applies out of network | — | Orthotic & Prosthetic Fee Schedule.xlsx |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $1,788.33since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $1,600.00since 2021-07-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS payment schedule (appendix to |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $1,200.00since 2019-01-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $1,158.87since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,154.89since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $1,107.46since 2019-01-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $992.96since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $900.00since 2023-03-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $772.65since 2022-04-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Hearing Aid / Audiol |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $752.00since 2019-07-24 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2019-07- |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $746.04since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $739.18since 2019-08-19 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $733.70since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $621.36since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Hearing Services Fee Schedule (AHCA Upda |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $516.00since 2019-03-01 | — | — | Not classified | — | CMAP fee schedule: 7/1/2025 MEDS - Heari |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $396.64since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Hearing Aid |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $65.00since 2019-01-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $32.53since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Hearing |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $0.00since 2024-03-26 | — | — | Not classified | — | Arkansas Medicaid Hearing Services Fee S |
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 V5221?
It depends on the state. Of the 20 states with a published fee-for-service rate, the median is $762.33. Georgia pays the most ($2,158.00) and Arkansas the least ($0.00).
Which state pays the highest Medicaid rate for V5221?
Georgia, at $2,158.00, effective 2019-10-01.
Do managed-care plans pay the same rate for V5221?
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.
Related Vision & hearing codes
92060Eye exams and vision services · 42 states92083Eye exams and vision services · 42 states92025Eye exams and vision services · 41 states92265Eye exams and vision services · 41 statesV2624Polishing/resurfacing of ocular prosthesis · 39 statesV2625Enlargement of ocular prosthesis · 38 states92609Therapy using a communication device · 37 statesV2626Reduction of ocular prosthesis · 37 statesV2628Fabrication and fitting of ocular conformer · 37 statesV2627Scleral cover shell · 36 statesV5264Ear mold/insert, not disposable, any type · 35 statesV5266Battery for use in hearing device · 35 states
Track V5221 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.