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Billing code 86256 · Lab & pathology

86256 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $12.04 for 86256 across 49 states, from $5.76 in Connecticut to $23.45 in Illinois.

Data as of Oct 5, 202649 statesEvery rate links to its official source

States publishing
49
National median
$12.04units vary by state
Lowest
$5.76Connecticut
Highest
$23.45Illinois
Answer

What does Medicaid pay for 86256?

49 state Medicaid programs publish a fee-for-service rate for 86256. The national median is $12.04 (units differ between states). Illinois pays the most, $23.45, and Connecticut the least, $5.76, a 4.1x spread.

State ranking

86256 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 49 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Illinois Source · since 2024-04-01$23.45——Plans negotiate; applies out of network—
2Iowa Source · since 2020-05-01$19.89——Plans must pay at least this—
3North Dakota Source · since 2025-07-01$19.53——Not classified—
24South Dakota Source · since 2020-01-01$12.05——Not classified—
25Montana Source · since 2020-01-01$12.04——Not classified—
26Louisiana Source · since 2012-07-01$12.00——Plans must pay at least this—
48Florida Source · since 2026-01-01$5.79——Plans negotiate; applies out of network—
49Connecticut Source · since 2015-01-01$5.76——Not classified—
See all 49 states for 86256 — start free

41 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 86256 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 86256?

It depends on the state. Of the 49 states with a published fee-for-service rate, the median is $12.04. Illinois pays the most ($23.45) and Connecticut the least ($5.76).

Which state pays the highest Medicaid rate for 86256?

Illinois, at $23.45, effective 2024-04-01.

Do managed-care plans pay the same rate for 86256?

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.