0861T 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 0861T, 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. 3 of the 7 states list more than one rate for 0861T, 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 0861T, so each amount is a flat payment for one service as the code defines it.
• Per hour. 0861T 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 0861T, 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 0861T run from $41.76 in Iowa to $4,132.69 in Rhode Island, a 99.0x gap in the same unit. Half the states pay more than the median of $1,089.83 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• 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.
• 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.
• Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.

Timing matters too. 7 states set the current rate for 0861T in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For 0861T, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 3 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 3 states is not classified yet.

• Plans negotiate; the published rate applies out of network (3 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 Rhode Island managed care.

0861T is a CPT Category III code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. Category III codes are temporary codes for emerging technology. Payers often price them case by case, so fewer states publish a fixed fee.

Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead. Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity.

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.