78609 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 78609, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 29 of the 33 states list more than one rate for 78609, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 33 states, 2 publish 78609 per unit and 1 per base unit, and 30 schedules print no unit at all (a flat amount per service).
• Per hour. 78609 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 78609, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 78609 run from $8.10 in New Jersey to $1,400.34 in New Mexico. The two publish it in different units (no unit printed versus base unit), so part of that gap is the unit rather than the price. Half the states pay more than the median of $68.92 and half pay less. The usual reasons for a spread like this in radiology rates:

• Imaging fees are split into a professional component (the reading) and a technical component (the equipment and staff), and states publish one, the other or a global amount.
• Advanced imaging such as CT, MRI and PET is often under separate pricing and prior-authorization policies that vary from state to state.
• States that benchmark imaging to Medicare use different percentages and different Medicare years.

Timing matters too. 18 states set the current rate for 78609 in 2026 or later, while 7 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for 78609 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 33 states.

In 6 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 15 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 12 states is not classified yet.

• Plans negotiate; the published rate applies out of network (15 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (6 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example New Mexico managed care.

78609 is a CPT radiology code in the radiology line, billed mostly by radiology groups, imaging centers and hospitals. Imaging codes are paid per study and split into a professional component (the reading, modifier 26) and a technical component (the equipment and staff, modifier TC). A global amount covers both.

Contrast agents and radiopharmaceuticals are usually billed separately under their own codes. Imaging is billed per study, with modifier 26 for the professional component and TC for the technical component; a claim without either is paid at the global amount where the state publishes one.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.