0697T Medicaid reimbursement rates by state
Outpatient hospital services (fee schedule). 6 state Medicaid programs publish a fee-for-service rate for 0697T. Rates run from $27.17 in Kansas to $950.50 in Connecticut, with a median of $382.26.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $382.26units vary by state
- Highest
- $950.50Connecticut
- Medicare (non-facility)
- —not on the physician fee schedule
0697T 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 |
|---|---|---|---|---|---|---|
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $950.50since 2026-01-01 | — | — | Not classified | — | CMAP Addendum B - OPPS Payment Type by P |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $498.47since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid ASC fee schedule (2026ASCFee |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $485.12since 2026-01-01 | — | — | Not classified | — | Arkansas Medicaid CY2026 Ambulatory Surg |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $279.40since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Final Ambulatory Surgery Center R |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $266.00since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $27.17since 2022-01-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Amb Surgical Cente |
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 0697T?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $382.26. Connecticut pays the most ($950.50) and Kansas the least ($27.17).
Which state pays the highest Medicaid rate for 0697T?
Connecticut, at $950.50, effective 2026-01-01.
Do managed-care plans pay the same rate for 0697T?
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.