86043 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 86043, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 11 of the 43 states list more than one rate for 86043, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. None of the 43 schedules prints a separate unit for 86043, so each amount is a flat payment for one service as the code defines it.
• Per hour. 86043 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 86043, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 86043 run from $6.02 in Nevada to $13.01 in Texas, a 2.2x gap in the same unit. Half the states pay more than the median of $10.42 and half pay less. The usual reasons for a spread like this in lab & pathology rates:

• Pathology services with an interpretation have professional and technical components that states price separately.
• Some states bundle certain tests into panels or into facility payments, so the separately billable amount differs.
• Fees for newer molecular and genetic tests are often set case by case, so fewer states publish them and the published amounts spread widely.

Timing matters too. 9 states set the current rate for 86043 in 2026 or later, while 1 state still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For 86043, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 6 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 24 states, plans negotiate and the published rate is a benchmark or out-of-network default (or a ceiling). The rule for the remaining 13 states is not classified yet.

• Plans negotiate; the published rate applies out of network (23 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (6 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Plans may pay no more than the published rate (1 state). Expect offers at or below the published rate. Higher payment would have to come from something other than the base rate, such as a quality or value-based arrangement.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Texas managed care.

86043 is a CPT pathology and laboratory code in the lab & pathology line, billed mostly by independent laboratories, hospital labs and pathology groups. Laboratory codes are paid per test; a panel is paid as one code, not as the sum of its tests. Pathology codes with an interpretation can be split into professional and technical components.

Pathology interpretation can be billed with modifier 26 when the laboratory and the pathologist bill separately. Laboratory tests are billed per test, and a panel is paid as a single code rather than as the sum of its component tests.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.