115 Medicaid reimbursement rates by state
EAPG relative weight (outpatient hospital or surgery center). 6 state Medicaid programs publish a fee-for-service rate for 115. Rates run from $1.83 in Georgia to $11.48 in Wisconsin, with a median of $3.30.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $3.30units vary by state
- Highest
- $11.48Wisconsin
- Medicare (non-facility)
- —not on the physician fee schedule
115 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 |
|---|---|---|---|---|---|---|
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $11.48since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $4.84since 2022-07-01 | Relative Weight | — | Plans negotiate; applies out of network | — | ASC EAPG Weights and Base Rate SFY 2023 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $3.50 | — | — | Plans negotiate; applies out of network | — | FY 2015 Outpatient Calculator (xls) |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $3.10since 2026-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service and managed care default rates) | $3.00since 2018-07-01 | days (average length of stay) | — | Suggested schedule for plans | — | NYS DOH Final APR-DRG Service Intensity |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $1.83since 2024-01-01 | weight | — | Plans negotiate; applies out of network | — | Georgia Inpatient DRG System - DRG Weigh |
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 115?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $3.30. Wisconsin pays the most ($11.48) and Georgia the least ($1.83 per weight).
Which state pays the highest Medicaid rate for 115?
Wisconsin, at $11.48, effective 2026-01-01.
Do managed-care plans pay the same rate for 115?
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.