538 Medicaid reimbursement rate by state (2026)
Inpatient DRG pricing input (outlier, cost ratio, stay). Medicaid pays a median of $0.7602 for 538 across 13 states, from $0.6716 in Iowa to $1,260.81 in New Hampshire.
- States publishing
- 13
- National median
- $0.7602units vary by state
- Lowest
- $0.6716Iowa
- Highest
- $1,260.81New Hampshire
What does Medicaid pay for 538?
13 state Medicaid programs publish a fee-for-service rate for 538. The national median is $0.7602 (units differ between states). New Hampshire pays the most, $1,260.81, and Iowa the least, $0.6716, a 1877.3x spread.
538 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 13 states with every variant, modifier and effective date.
Frequently asked questions
What does Medicaid pay for 538?
It depends on the state. Of the 13 states with a published fee-for-service rate, the median is $0.7602. New Hampshire pays the most ($1,260.81) and Iowa the least ($0.6716).
Which state pays the highest Medicaid rate for 538?
New Hampshire, at $1,260.81, effective 2025-10-01.
Do managed-care plans pay the same rate for 538?
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 workspace shows the rule for each state, cited to the contract or statute.