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Billing code 80204 · Lab & pathology

80204 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $34.01 for 80204 across 43 states, from $11.18 in Rhode Island to $41.65 in Texas.

Data as of Oct 5, 202643 statesEvery rate links to its official source

States publishing
43
National median
$34.01units vary by state
Lowest
$11.18Rhode Island
Highest
$41.65Texas
Answer

What does Medicaid pay for 80204?

43 state Medicaid programs publish a fee-for-service rate for 80204. The national median is $34.01 (units differ between states). Texas pays the most, $41.65, and Rhode Island the least, $11.18, a 3.7x spread.

State ranking

80204 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 43 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Texas Source · since 2019-07-04$41.65——Plans negotiate; applies out of network—
2Arizona Source · since 2026-10-01$38.57——Plans negotiate; applies out of network—
3Nebraska Source · since 2026-07-01$38.57——Plans negotiate; applies out of network—
21Oklahoma Source · since 2024-01-01$34.31——Plans must pay at least this—
22Massachusetts Source · since 2024-09-01$34.01——Plans negotiate; applies out of network—
23Virginia Source · since 2021-01-01$33.94——Plans negotiate; applies out of network—
42Florida Source · since 2026-01-01$11.75——Plans negotiate; applies out of network—
43Rhode Island Source · since 2021-01-01$11.18——Plans negotiate; applies out of network—
See all 43 states for 80204 — start free

35 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 80204 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 80204?

It depends on the state. Of the 43 states with a published fee-for-service rate, the median is $34.01. Texas pays the most ($41.65) and Rhode Island the least ($11.18).

Which state pays the highest Medicaid rate for 80204?

Texas, at $41.65, effective 2019-07-04.

Do managed-care plans pay the same rate for 80204?

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.