0472 Medicaid reimbursement rates by state
Outpatient hospital services (fee schedule). 5 state Medicaid programs publish a fee-for-service rate for 0472. Rates run from $0.1862 in Washington to $9.75 in Wyoming, with a median of $1.37.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $1.37units vary by state
- Highest
- $9.75Wyoming
- Medicare (non-facility)
- —not on the physician fee schedule
0472 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.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $9.75since 2021-01-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $2.22since 2025-10-01 | — | — | Plans must pay at least this | — | DRG Base Rate Oct 2025 - web (OKLAHOMA H |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $1.37since 2026-01-01 | weight | — | Plans must pay at least this | — | Utah Medicaid MS-DRG Payment Calculation |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $1.00since 2026-07-01 | factor | — | Plans expected to pay at least this | — | Florida Medicaid DRG Rate Worksheet SFY |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service hospital rates | $0.1862since 2022-07-01 | — | — | Plans must pay at least this | — | opps-weights-20220701.xlsx |
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 0472?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $1.37. Wyoming pays the most ($9.75) and Washington the least ($0.1862).
Which state pays the highest Medicaid rate for 0472?
Wyoming, at $9.75, effective 2021-01-01.
Do managed-care plans pay the same rate for 0472?
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.