459 Medicaid reimbursement rates by state
Outpatient hospital services (fee schedule). 6 state Medicaid programs publish a fee-for-service rate for 459. Rates run from $0.0541 in Illinois to $12.00 in Arkansas, with a median of $0.1161.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $0.1161units vary by state
- Highest
- $12.00Arkansas
- Medicare (non-facility)
- —not on the physician fee schedule
459 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 |
|---|---|---|---|---|---|---|
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $12.00since 2025-05-16 | — | — | Not classified | — | Arkansas Medicaid Hospital / Critical Ac |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $8.40since 2024-04-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $0.1495since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $0.0827since 2026-01-01 | relative weight | — | Plans negotiate; applies out of network | — | NYS DOH APG-Based Weights History File ( |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $0.0656since 2024-07-01 | Relative Weight | — | Plans negotiate; applies out of network | — | ASC EAPG Weights and Base Rate SFY 2025 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $0.0541since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
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 459?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $0.1161. Arkansas pays the most ($12.00) and Illinois the least ($0.0541).
Which state pays the highest Medicaid rate for 459?
Arkansas, at $12.00, effective 2025-05-16.
Do managed-care plans pay the same rate for 459?
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.