V5264 Medicaid reimbursement rates by state
Ear mold/insert, not disposable, any type. 32 state Medicaid programs publish a fee-for-service rate for V5264 at the physician psychologist level. Rates run from $18.13 in Florida to $58.20 in South Carolina, with a median of $39.44.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 32
- Median rate
- $39.44units vary by state
- Highest
- $58.20South Carolina
- Medicare (non-facility)
- —not on the physician fee schedule
V5264 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 |
|---|---|---|---|---|---|---|
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $58.20since 2011-04-08 | — | — | Not classified | — | SCDHHS Pediatric Subspecialty and Neonat |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $57.78since 2012-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $56.05since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $52.17since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $51.18since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Hearing |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $48.00since 2010-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $46.82since 2020-08-01 | — | — | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $46.48since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $45.77since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $45.54since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Hearing Services Fee Schedule data |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $45.50since 2026-01-01 | per unit | — | Not classified | — | MaineCare Section 109, Speech and Hearin |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $45.31since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2024-01- |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $45.00since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | Orthotic and Prosthetic Fee Schedule - E |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $42.87since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $40.00since 2005-12-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $40.00since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Audiology fee schedule (2022 |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $38.87since 2021-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Hearing hardware fee schedule (heari |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $38.82since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $36.46since 2026-06-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $35.00since 2004-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $34.75since 2026-04-01 | — | — | Plans must pay at least this | — | BMS DME 2026 Rural Fee Schedule Effectiv |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $32.00since 2007-05-01 | — | — | Not classified | — | CMAP fee schedule: 7/1/2025 MEDS - Heari |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $30.73since 2013-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $30.30since 2022-04-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Hearing Aid / Audiol |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $30.00since 2006-07-01 | — | — | Plans must pay at least this | — | Provider Type 23 Hearing Aid Dispenser & |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $27.52since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $27.00since 2002-01-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $26.53since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $25.76since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Hearing Aid |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $24.25since 2010-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS payment schedule (appendix to |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $18.15since 2003-10-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $18.13since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Hearing Services Fee Schedule (AHCA Upda |
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 V5264?
It depends on the state. Of the 32 states with a published fee-for-service rate, the median is $39.44. South Carolina pays the most ($58.20) and Florida the least ($18.13).
Which state pays the highest Medicaid rate for V5264?
South Carolina, at $58.20, effective 2011-04-08.
Do managed-care plans pay the same rate for V5264?
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
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Track V5264 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.