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Billing code 85520 · Lab & pathology

85520 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $11.78 for 85520 across 50 states, from $4.39 in Virginia to $16.46 in Georgia.

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

States publishing
50
National median
$11.78units vary by state
Lowest
$4.39Virginia
Highest
$16.46Georgia
Answer

What does Medicaid pay for 85520?

50 state Medicaid programs publish a fee-for-service rate for 85520. The national median is $11.78 (units differ between states). Georgia pays the most, $16.46, and Virginia the least, $4.39, a 3.7x spread.

State ranking

85520 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$16.46——Plans negotiate; applies out of network—
2North Carolina Source · since 2025-10-01$16.14——Plans must pay at least this—
3New Mexico Source · since 2023-07-01$15.71——Plans must pay at least this—
25West Virginia Source · since 2023-04-01$11.78——Plans negotiate; applies out of network—
26Wyoming Source · since 2025-09-01$11.78——Not classified—
27Oklahoma Source · since 2024-01-01$11.64——Plans must pay at least this—
49Florida Source · since 2026-01-01$6.28——Plans negotiate; applies out of network—
50Virginia Source · since 2014-07-01$4.39——Plans negotiate; applies out of network—
See all 50 states for 85520 — 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 85520 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 85520?

It depends on the state. Of the 50 states with a published fee-for-service rate, the median is $11.78. Georgia pays the most ($16.46) and Virginia the least ($4.39).

Which state pays the highest Medicaid rate for 85520?

Georgia, at $16.46, effective 2017-01-01.

Do managed-care plans pay the same rate for 85520?

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.