00864 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 15 of the 39 states publish 00864 per base unit, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 18 of the 39 states list more than one rate for 00864, 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 39 states, 15 publish 00864 per base unit, 2 per minute, 1 per unit and 4 in other units, and 17 schedules print no unit at all (a flat amount per service).
• Per hour. 00864 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 00864, 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 00864 run from $0.96 in Idaho to $168.96 in Oregon. The two publish it in different units (no unit printed versus minute), so part of that gap is the unit rather than the price. Half the states pay more than the median of $8.00 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• Each state sets its own physician conversion factor or fee for every code, and many update them on a state budget cycle rather than on Medicare's calendar.
• Modifiers such as professional or technical component, bilateral, multiple procedure and assistant at surgery change the amount paid, and states apply them with their own percentages.
• Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.

Timing matters too. 10 states set the current rate for 00864 in 2026 or later, while 18 states 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 00864, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 8 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 21 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 10 states is not classified yet.

• Plans negotiate; the published rate applies out of network (21 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 (8 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.

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 Oregon managed care.

00864 is a CPT anesthesia code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. Anesthesia is commonly paid on base units plus time units multiplied by a conversion factor, so a published amount can be a base value or a conversion factor rather than a full payment. Read the unit column before comparing.

Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type. Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead.

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.