523 Medicaid reimbursement rates by state
Inpatient DRG pricing input (outlier, cost ratio, stay). 7 state Medicaid programs publish a fee-for-service rate for 523. Rates run from $0.1653 in Illinois to $8.00 in North Carolina, with a median of $0.3995.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $0.3995units vary by state
- Highest
- $8.00North Carolina
- Medicare (non-facility)
- —not on the physician fee schedule
523 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 |
|---|---|---|---|---|---|---|
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $8.00⚠ over 3× mediansince 2026-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $6.94⚠ over 3× mediansince 2026-10-01 | — | — | Not classified | — | DVHA Relative Weights Effective 10/1/202 |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $0.6667since 2026-01-01 | relative weight | — | Plans negotiate; applies out of network | — | NYS DOH APG-Based Weights History File ( |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $0.3995since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $0.2078since 2022-07-01 | EAPG WEIGHT | — | Plans negotiate; applies out of network | — | EAPG Weights Version 3.16 |
| District of ColumbiaAny qualified provider (rate does not vary by provider) · DC Medicaid FFS (hospital) | $0.1956since 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) | $0.1653since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
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 523?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $0.3995. North Carolina pays the most ($8.00) and Illinois the least ($0.1653).
Which state pays the highest Medicaid rate for 523?
North Carolina, at $8.00, effective 2026-10-01.
Do managed-care plans pay the same rate for 523?
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.