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Billing code 85613 · Lab & pathology

85613 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $8.62 for 85613 across 50 states, from $4.60 in Florida to $12.03 in Georgia.

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

States publishing
50
National median
$8.62units vary by state
Lowest
$4.60Florida
Highest
$12.03Georgia
Answer

What does Medicaid pay for 85613?

50 state Medicaid programs publish a fee-for-service rate for 85613. The national median is $8.62 (units differ between states). Georgia pays the most, $12.03, and Florida the least, $4.60, a 2.6x spread.

State ranking

85613 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$12.03——Plans negotiate; applies out of network—
2North Carolina Source · since 2025-10-01$11.80——Plans must pay at least this—
3Pennsylvania Source · since 2009-04-09$11.68——Plans negotiate; applies out of network—
25Mississippi Source · since 2022-07-01$8.62——Plans must pay at least this—
26West Virginia Source · since 2023-04-01$8.62——Plans negotiate; applies out of network—
27Wyoming Source · since 2025-09-01$8.62——Not classified—
49Rhode Island Source · since 2005-01-01$5.38——Plans negotiate; applies out of network—
50Florida Source · since 2026-01-01$4.60——Plans negotiate; applies out of network—
See all 50 states for 85613 — 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 85613 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 85613?

It depends on the state. Of the 50 states with a published fee-for-service rate, the median is $8.62. Georgia pays the most ($12.03) and Florida the least ($4.60).

Which state pays the highest Medicaid rate for 85613?

Georgia, at $12.03, effective 2017-01-01.

Do managed-care plans pay the same rate for 85613?

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.