V5265 Medicaid reimbursement rates by state
Ear mold/insert, disposable, any type. 9 state Medicaid programs publish a fee-for-service rate for V5265 at the physician psychologist level. Rates run from $10.00 in New Jersey to $250.00 in Missouri, with a median of $35.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 9
- Median rate
- $35.00units vary by state
- Highest
- $250.00Missouri
- Medicare (non-facility)
- —not on the physician fee schedule
V5265 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 |
|---|---|---|---|---|---|---|
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $250.00⚠ over 3× mediansince 2013-09-01 | — | — | Paid by the state, outside plans | — | MO HealthNet fee schedule: First Steps |
| 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 |
| AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health) | $50.00since 2026-07-01 | — | — | Not classified | — | Alaska Medicaid Audiology Fee Schedule S |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $45.00since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $35.00since 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) | $24.51since 2021-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $22.00since 2024-04-01 | — | — | Plans must pay at least this | — | Provider Type 23 Hearing Aid Dispenser & |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $15.00since 2005-12-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $10.00since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
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 V5265?
It depends on the state. Of the 9 states with a published fee-for-service rate, the median is $35.00. Missouri pays the most ($250.00) and New Jersey the least ($10.00).
Which state pays the highest Medicaid rate for V5265?
Missouri, at $250.00, effective 2013-09-01.
Do managed-care plans pay the same rate for V5265?
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.