097 Medicaid reimbursement rates by state
Inpatient DRG pricing input (outlier, cost ratio, stay). 6 state Medicaid programs publish a fee-for-service rate for 097. Rates run from $2.00 in New York to $78.00 in Kansas, with a median of $3.17.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $3.17units vary by state
- Highest
- $78.00Kansas
- Medicare (non-facility)
- —not on the physician fee schedule
097 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 |
|---|---|---|---|---|---|---|
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid (KMAP fee-for-service schedule) | $78.00since 2023-01-01 | — | — | Plans must pay at least this | — | KMAP Hospital Fee-for-Service Provider M |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $10.90since 2023-04-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $3.61since 2025-10-01 | Weights - 10% Cap Applied | — | Not classified | — | MS-DRG relative weights FY 2026 Final Ru |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $2.72since 2024-01-01 | weight | — | Plans negotiate; applies out of network | — | Georgia Inpatient DRG System - DRG Weigh |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $2.37since 2024-10-01 | — | — | Plans must pay at least this | — | DRG Data Table for 2024-10-01 Iowa Weigh |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service and managed care default rates) | $2.00since 2018-07-01 | days (average length of stay) | — | Suggested schedule for plans | — | NYS DOH Final APR-DRG Service Intensity |
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 097?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $3.17. Kansas pays the most ($78.00) and New York the least ($2.00 per days (average length of stay)).
Which state pays the highest Medicaid rate for 097?
Kansas, at $78.00, effective 2023-01-01.
Do managed-care plans pay the same rate for 097?
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.