167 Medicaid reimbursement rates by state
EAPG relative weight (outpatient hospital or surgery center). 6 state Medicaid programs publish a fee-for-service rate for 167. Rates run from $6.50 in North Carolina to $21.28 in Wisconsin, with a median of $7.98.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $7.98units vary by state
- Highest
- $21.28Wisconsin
- Medicare (non-facility)
- —not on the physician fee schedule
167 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) | $21.28since 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) | $8.95since 2022-07-01 | EAPG WEIGHT | — | Plans negotiate; applies out of network | — | EAPG Weights Version 3.16 |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service and managed care default rates) | $8.00since 2018-07-01 | days (average length of stay) | — | Suggested schedule for plans | — | NYS DOH Final APR-DRG Service Intensity |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $7.96since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $6.95since 2024-01-01 | weight | — | Plans negotiate; applies out of network | — | Georgia Inpatient DRG System - DRG Weigh |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $6.50since 2026-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
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 167?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $7.98. Wisconsin pays the most ($21.28) and North Carolina the least ($6.50).
Which state pays the highest Medicaid rate for 167?
Wisconsin, at $21.28, effective 2026-01-01.
Do managed-care plans pay the same rate for 167?
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.