861 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 861, 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. 4 of the 8 states list more than one rate for 861, 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. Of the 8 states, 2 publish 861 per relative weight, 1 per weight and 1 per policy_adjuster_adult, and 4 schedules print no unit at all (a flat amount per service).
• Per hour. 861 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 861, 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 861 run from $0.2379 in Illinois to $356.49 in Vermont, a 1498.5x gap in the same unit. Half the states pay more than the median of $0.7602 and half pay less. The usual reasons for a spread like this in hospital outpatient rates:

• States pay outpatient hospital care under different systems: grouped payments, a fee schedule or a percentage of charges.
• Many outpatient amounts are hospital-specific or adjusted by hospital type.

Timing matters too. 3 states set the current rate for 861 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for 861 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 8 states.

In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 5 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet.

• Plans negotiate; the published rate applies out of network (5 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.
• The state sets the plan rate (1 state). There is little to negotiate on price. Contracting is about network participation, authorization and billing terms.
• Plans must pay at least the published rate (1 state). 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.

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 Vermont managed care.

861 is a revenue code in the hospital outpatient line, billed mostly by hospital outpatient departments. Revenue codes identify a facility's accommodation or cost center on an institutional claim. Day-rate services such as hospice and nursing facility care are billed per day under them.

Outpatient services are billed per procedure, and some systems package lower-cost items into the payment for the main service.

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.