2016 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 2016, 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. 1 of the 5 states list more than one rate for 2016, 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. Of the 5 states, 2 publish 2016 per relative weight, and 3 schedules print no unit at all (a flat amount per service).
• Per hour. 2016 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 2016, 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 2016 run from $0.0628 in Virginia to $1.38 in New York, a 22.0x gap in the same unit. Half the states pay more than the median of $0.0646 and half pay less. The usual reasons for a spread like this in hospital outpatient rates:

• States pay outpatient hospital care under different systems: grouped payments, a fee schedule or a percentage of charges.
• Many outpatient amounts are hospital-specific or adjusted by hospital type.

Timing matters too. 2 states set the current rate for 2016 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 2016. 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 4 states, plans negotiate and the published rate is a benchmark or out-of-network default.

• Plans negotiate; the published rate applies out of network (4 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 New York managed care.

2016 is a revenue code in the hospital outpatient line, billed mostly by hospital outpatient departments. Revenue codes identify a facility's accommodation or cost center on an institutional claim. Day-rate services such as hospice and nursing facility care are billed per day under them.

Outpatient services are billed per procedure, and some systems package lower-cost items into the payment for the main service.

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.