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0038U Medicaid reimbursement rates by state

Clinical lab tests. 9 state Medicaid programs publish a fee-for-service rate for 0038U at the independent level. Rates run from $7.25 in Kansas to $29.60 in Arizona, with a median of $26.64.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
9
Median rate
$26.64units vary by state
Highest
$29.60Arizona
Medicare (non-facility)
—not on the physician fee schedule

0038U rate in every state

One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$29.60since 2026-10-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Clinical
KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules)$29.60since 2020-01-01——Plans negotiate; applies out of network—KY Medicaid Clinical Lab fee schedule (2
MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service)$29.59since 2021-07-01——Not classified—Montana Healthcare Programs fee schedule
MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service)$26.64since 2026-07-01——Plans negotiate; applies out of network—MO HealthNet fee schedule: Independent L
MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service)$26.64since 2026-07-01——Plans must pay at least this—DOM Comprehensive Fee Schedule, Septembe
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$23.68since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d
FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service)$15.98since 2026-01-01——Plans negotiate; applies out of network—Independent Laboratory Fee Schedule (202
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$14.80since 2026-07-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule$7.25since 2021-01-01——Not classified—KMAP Fee Schedule QMB Medicaid (FeeSched

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 with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.

Frequently asked questions

What does Medicaid pay for 0038U?

It depends on the state. Of the 9 states with a published fee-for-service rate, the median is $26.64. Arizona pays the most ($29.60) and Kansas the least ($7.25).

Which state pays the highest Medicaid rate for 0038U?

Arizona, at $29.60, effective 2026-10-01.

Do managed-care plans pay the same rate for 0038U?

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 table shows the rule for each state, cited to the contract or statute.

Related Lab & pathology codes

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