461 Medicaid reimbursement rates by state
Inpatient DRG pricing input (outlier, cost ratio, stay). 15 state Medicaid programs publish a fee-for-service rate for 461. Rates run from $1.00 in Hawaii to $3,932.53 in New Hampshire, with a median of $6.14.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 15
- Median rate
- $6.14units vary by state
- Highest
- $3,932.53New Hampshire
- Medicare (non-facility)
- —not on the physician fee schedule
461 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 |
|---|---|---|---|---|---|---|
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $3,932.53⚠ over 3× mediansince 2025-10-01 | — | — | Plans must pay at least this | — | DRG Relative Weight Price Report General |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid (KMAP fee-for-service schedule) | $78.00⚠ over 3× mediansince 2023-01-01 | — | — | Plans must pay at least this | — | KMAP Hospital Fee-for-Service Provider M |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $8.51since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | West Virginia Rate Year 2026 DRG Paramet |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $8.26since 2026-09-24 | — | — | Plans must pay at least this | — | Medicaid DRG Weights V43 Grouper |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $6.94since 2025-10-01 | — | — | Not classified | — | DVHA Relative Weights Effective 10/1/202 |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $6.50since 2026-10-01 | — | — | 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) | $6.23since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $6.14since 2024-10-01 | — | — | Plans must pay at least this | — | DRG Data Table for 2024-10-01 Iowa Weigh |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service and managed care default rates) | $6.00since 2018-07-01 | days (average length of stay) | — | Suggested schedule for plans | — | NYS DOH Final APR-DRG Service Intensity |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $5.52since 2025-10-01 | Weights - 10% Cap Applied | — | Not classified | — | MS-DRG relative weights FY 2026 Final Ru |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $3.83since 2022-07-01 | Relative Weight | — | Plans negotiate; applies out of network | — | ASC EAPG Weights and Base Rate SFY 2023 |
| District of ColumbiaAny qualified provider (rate does not vary by provider) · DC Medicaid FFS (hospital) | $2.86since 2024-10-01 | — | — | Plans must pay at least this | — | DC EAPG Relative Weights FY2026 (DCO2500 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $2.49since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $1.43since 2024-01-01 | weight | — | Plans negotiate; applies out of network | — | Georgia Inpatient DRG System - DRG Weigh |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $1.00since 2024-01-01 | policy_adjuster_adult | — | State sets the plan rate | — | Hawai`i January 2026 v1.0 DRG Calculator |
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 461?
It depends on the state. Of the 15 states with a published fee-for-service rate, the median is $6.14. New Hampshire pays the most ($3,932.53) and Hawaii the least ($1.00 per policy_adjuster_adult).
Which state pays the highest Medicaid rate for 461?
New Hampshire, at $3,932.53, effective 2025-10-01.
Do managed-care plans pay the same rate for 461?
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.