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Billing code 81165 · Lab & pathology

81165 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $250.54 for 81165 across 48 states, from $141.44 in Nevada to $305.51 in Texas.

Data as of Oct 5, 202648 statesEvery rate links to its official source

States publishing
48
National median
$250.54units vary by state
Lowest
$141.44Nevada
Highest
$305.51Texas
Answer

What does Medicaid pay for 81165?

48 state Medicaid programs publish a fee-for-service rate for 81165. The national median is $250.54 (units differ between states). Texas pays the most, $305.51, and Nevada the least, $141.44, a 2.2x spread.

State ranking

81165 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 48 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Texas Source · since 2019-07-04$305.51——Plans negotiate; applies out of network—
2Montana Source · since 2020-01-01$282.88——Not classified—
3Rhode Island Source · since 2022-07-01$282.88——Plans negotiate; applies out of network—
24Oklahoma Source · since 2024-01-01$251.62——Plans must pay at least this—
25Massachusetts Source · since 2024-09-01$249.46——Plans negotiate; applies out of network—
26Virginia Source · since 2019-01-01$248.93——Plans negotiate; applies out of network—
47Florida Source · since 2026-01-01$152.76——Plans negotiate; applies out of network—
48Nevada Source · since 2019-01-01$141.44——Plans negotiate; applies out of network—
See all 48 states for 81165 — start free

40 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 81165 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 81165?

It depends on the state. Of the 48 states with a published fee-for-service rate, the median is $250.54. Texas pays the most ($305.51) and Nevada the least ($141.44).

Which state pays the highest Medicaid rate for 81165?

Texas, at $305.51, effective 2019-07-04.

Do managed-care plans pay the same rate for 81165?

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.