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Billing code 81258 · Lab & pathology

81258 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $333.78 for 81258 across 37 states, from $65.27 in Connecticut to $405.27 in Texas.

Data as of Oct 5, 202637 statesEvery rate links to its official source

States publishing
37
National median
$333.78units vary by state
Lowest
$65.27Connecticut
Highest
$405.27Texas
Answer

What does Medicaid pay for 81258?

37 state Medicaid programs publish a fee-for-service rate for 81258. The national median is $333.78 (units differ between states). Texas pays the most, $405.27, and Connecticut the least, $65.27, a 6.2x spread.

State ranking

81258 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 37 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Texas Source · since 2019-07-04$405.27——Plans negotiate; applies out of network—
2Montana Source · since 2018-07-01$375.25——Not classified—
3Indiana Source · since 2018-01-01$375.25unit—Plans must pay at least this—
18West Virginia Source · since 2023-04-01$337.73——Plans negotiate; applies out of network—
19Oklahoma Source · since 2024-01-01$333.78——Plans must pay at least this—
20Massachusetts Source · since 2024-09-01$330.92——Plans negotiate; applies out of network—
36New York Source · since 2020-05-29$94.17——Plans negotiate; applies out of network—
37Connecticut Source · since 2018-01-01$65.27——Not classified—
See all 37 states for 81258 — start free

29 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 81258 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 81258?

It depends on the state. Of the 37 states with a published fee-for-service rate, the median is $333.78. Texas pays the most ($405.27) and Connecticut the least ($65.27).

Which state pays the highest Medicaid rate for 81258?

Texas, at $405.27, effective 2019-07-04.

Do managed-care plans pay the same rate for 81258?

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.