0496U Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 0496U, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 2 of the 7 states list more than one rate for 0496U, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. None of the 7 schedules prints a separate unit for 0496U, so each amount is a flat payment for one service as the code defines it.
• Per hour. 0496U is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 0496U, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 0496U run from $262.37 in Florida to $485.86 in Montana, a 1.9x gap in the same unit. Half the states pay more than the median of $485.86 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• Primary-care and pediatric add-ons, enhanced rates for certain specialties and targeted increases for access problems change individual codes without moving the rest of the schedule.
• Modifiers such as professional or technical component, bilateral, multiple procedure and assistant at surgery change the amount paid, and states apply them with their own percentages.
• Each state sets its own physician conversion factor or fee for every code, and many update them on a state budget cycle rather than on Medicare's calendar.

Timing matters too. 7 states set the current rate for 0496U in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

No managed-care plan publishes what it pays for 0496U. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 5 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet.

• Plans negotiate; the published rate applies out of network (5 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (1 state). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Montana managed care.

0496U is a CPT proprietary laboratory analysis code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. PLA codes identify a specific laboratory's test and are paid per test.

Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity. Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.