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Billing code 85210 · Lab & pathology

85210 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $11.68 for 85210 across 50 states, from $3.35 in Virginia to $16.33 in Georgia.

Data as of Oct 5, 202650 statesEvery rate links to its official source

States publishing
50
National median
$11.68units vary by state
Lowest
$3.35Virginia
Highest
$16.33Georgia
Answer

What does Medicaid pay for 85210?

50 state Medicaid programs publish a fee-for-service rate for 85210. The national median is $11.68 (units differ between states). Georgia pays the most, $16.33, and Virginia the least, $3.35, a 4.9x spread.

State ranking

85210 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 50 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Georgia Source · since 2017-01-01$16.33——Plans negotiate; applies out of network—
2North Carolina Source · since 2025-10-01$16.01——Plans must pay at least this—
3Wyoming Source · since 2021-01-01$15.92——Not classified—
25Mississippi Source · since 2022-07-01$11.68——Plans must pay at least this—
26West Virginia Source · since 2023-04-01$11.68——Plans negotiate; applies out of network—
27Oklahoma Source · since 2024-01-01$11.55——Plans must pay at least this—
49Rhode Island Source · since 2005-01-01$3.90——Plans negotiate; applies out of network—
50Virginia Source · since 2014-07-01$3.35——Plans negotiate; applies out of network—
See all 50 states for 85210 — start free

42 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 85210 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 85210?

It depends on the state. Of the 50 states with a published fee-for-service rate, the median is $11.68. Georgia pays the most ($16.33) and Virginia the least ($3.35).

Which state pays the highest Medicaid rate for 85210?

Georgia, at $16.33, effective 2017-01-01.

Do managed-care plans pay the same rate for 85210?

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.