969 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 969, 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 9 states list more than one rate for 969, 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 9 states, 1 publish 969 per weights - 10% cap applied, and 8 schedules print no unit at all (a flat amount per service).
• Per hour. 969 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 969, 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 969 run from $6.12 in Oregon to $2,197.89 in New Hampshire. The two publish it in different units (no unit printed versus Weights - 10% Cap Applied), so part of that gap is the unit rather than the price. Half the states pay more than the median of $12.70 and half pay less. The usual reasons for a spread like this in hospital inpatient rates:

• States use different inpatient grouper systems, so a diagnosis-related group weight in one state is not comparable with a weight from another grouper.
• Base rates are often hospital-specific, adjusted for wages, teaching and other factors, so the same weight produces a different payment at each hospital.
• Some states still pay certain hospitals or stays per day instead of per discharge.

Timing matters too. 3 states set the current rate for 969 in 2026 or later. 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 969, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 5 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 1 state, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 3 states is not classified yet.

• Plans must pay at least the published rate (5 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 negotiate; the published rate applies out of network (1 state). 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.

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 New Hampshire managed care.

969 is a inpatient DRG in the hospital inpatient line, billed mostly by hospitals. Inpatient stays are paid per discharge: a diagnosis-related group weight multiplied by a hospital base rate, with outlier payments for unusually costly stays. A value on this page can therefore be a weight or a pricing input, not dollars.

A value here may be a relative weight, an average length of stay, an outlier threshold or another pricing input. The payment is the weight multiplied by the hospital's base rate.

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.