0474U Medicaid reimbursement rates by state
Clinical lab tests. 5 state Medicaid programs publish a fee-for-service rate for 0474U. Rates run from $704.13 in Florida to $1,303.95 in Kentucky, with a median of $1,173.56.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $1,173.56units vary by state
- Highest
- $1,303.95Kentucky
- Medicare (non-facility)
- —not on the physician fee schedule
0474U 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 |
|---|---|---|---|---|---|---|
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $1,303.95since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Clinical Lab fee schedule (2 |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $1,173.56since 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) | $1,173.56since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $1,036.64since 2026-02-01 | — | — | Not classified | — | Maryland Medicaid Medical Laboratory Fee |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $704.13since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Independent Laboratory Fee Schedule (202 |
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 0474U?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $1,173.56. Kentucky pays the most ($1,303.95) and Florida the least ($704.13).
Which state pays the highest Medicaid rate for 0474U?
Kentucky, at $1,303.95, effective 2025-01-01.
Do managed-care plans pay the same rate for 0474U?
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.