V5259 Medicaid reimbursement rates by state
Hearing aid, digital, binaural, itc. 22 state Medicaid programs publish a fee-for-service rate for V5259 at the physician psychologist level. Rates run from $32.53 in Wisconsin to $3,200.00 in Mississippi, with a median of $1,057.09.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 22
- Median rate
- $1,057.09units vary by state
- Highest
- $3,200.00Mississippi
- Medicare (non-facility)
- —not on the physician fee schedule
V5259 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 |
|---|---|---|---|---|---|---|
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $3,200.00⚠ over 3× mediansince 2013-12-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $2,651.00since 2020-04-01 | — | — | Plans negotiate; applies out of network | — | Orthotic and Prosthetic Fee Schedule 2nd |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $2,390.00since 2005-12-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $2,350.00since 2008-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $1,750.00since 2026-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $1,699.00since 2019-05-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #17 AUDIOLOGI |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,470.98since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $1,221.89since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $1,200.00since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $1,129.79since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $1,060.45since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $1,053.73since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $1,050.00since 2009-01-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $927.90since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $900.00since 2023-09-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Hearing Aid Dealers Fee Schedule d |
| 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 |
| 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- |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $700.00since 2002-01-01 | — | — | Plans must pay at least this | — | Provider Type 23 Hearing Aid Dispenser & |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $600.00since 2016-03-01 | — | — | 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 2006-03-01 | — | — | 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 |
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 V5259?
It depends on the state. Of the 22 states with a published fee-for-service rate, the median is $1,057.09. Mississippi pays the most ($3,200.00) and Wisconsin the least ($32.53).
Which state pays the highest Medicaid rate for V5259?
Mississippi, at $3,200.00, effective 2013-12-01.
Do managed-care plans pay the same rate for V5259?
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
V2623Prosthetic eye, plastic, custom · 45 statesV2624Polishing/resurfacing of ocular prosthesis · 45 statesV2625Enlargement of ocular prosthesis · 44 states92609Therapy using a communication device · 43 statesV2626Reduction of ocular prosthesis · 43 statesV2628Fabrication and fitting of ocular conformer · 43 statesV2627Scleral cover shell · 42 statesV5264Ear mold/insert, not disposable, any type · 40 statesV5266Battery for use in hearing device · 39 statesV2020Frames, purchases · 37 statesV2100Sphere, single vision, plano to plus or minus 4.00, per lens · 36 statesV2101Sphere, single vision · 36 states
Track V5259 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.