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Billing code 785 · Hospital inpatient

785 Medicaid reimbursement rate by state (2026)

Inpatient DRG pricing input (outlier, cost ratio, stay). Medicaid pays a median of $0.8825 for 785 across 13 states, from $0.2431 in Illinois to $1,624.95 in New Hampshire.

Data as of Oct 5, 202613 statesEvery rate links to its official source

States publishing
13
National median
$0.8825units vary by state
Lowest
$0.2431Illinois
Highest
$1,624.95New Hampshire
Answer

What does Medicaid pay for 785?

13 state Medicaid programs publish a fee-for-service rate for 785. The national median is $0.8825 (units differ between states). New Hampshire pays the most, $1,624.95, and Illinois the least, $0.2431, a 6684.3x spread.

State ranking

785 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.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1New Hampshire Source · since 2025-10-01$1,624.95——Plans must pay at least this—
2Kansas Source · since 2023-01-01$78.00——Plans must pay at least this—
3North Carolina Source · since 2026-10-01$2.20——Plans must pay at least this—
6Vermont Source · since 2025-10-01$0.9101——Not classified—
7West Virginia Source · since 2025-10-01$0.8825——Plans negotiate; applies out of network—
8Iowa Source · since 2024-10-01$0.8021——Plans must pay at least this—
12Virginia Source · since 2022-07-01$0.2953EAPG WEIGHT—Plans negotiate; applies out of network—
13Illinois Source · since 2023-08-01$0.2431——Plans negotiate; applies out of network—
See all 13 states for 785 — start free

5 more states, with every modifier and provider-type variant, rate history and the plan rule in each state. 14-day free trial, no credit card.

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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; states with several Medicare localities show a range. Confirm rates with the payer before billing.

Track 785 in your states. Get an alert when any state changes it, with every variant and the managed-care rule.
FAQ

Frequently asked questions

What does Medicaid pay for 785?

It depends on the state. Of the 13 states with a published fee-for-service rate, the median is $0.8825. New Hampshire pays the most ($1,624.95) and Illinois the least ($0.2431).

Which state pays the highest Medicaid rate for 785?

New Hampshire, at $1,624.95, effective 2025-10-01.

Do managed-care plans pay the same rate for 785?

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.