169 Medicaid reimbursement rates by state
Inpatient DRG pricing input (outlier, cost ratio, stay). 5 state Medicaid programs publish a fee-for-service rate for 169. Rates run from $0.4689 in Virginia to $8.00 in New York, with a median of $1.52.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $1.52units vary by state
- Highest
- $8.00New York
- Medicare (non-facility)
- —not on the physician fee schedule
169 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 |
|---|---|---|---|---|---|---|
| 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 |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $5.30since 2024-01-01 | weight | — | Plans negotiate; applies out of network | — | Georgia Inpatient DRG System - DRG Weigh |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $1.52 | — | — | Plans negotiate; applies out of network | — | FY 2015 Outpatient Calculator (xls) |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $1.00since 2024-01-01 | policy_adjuster_adult | — | State sets the plan rate | — | Hawai`i January 2026 v1.0 DRG Calculator |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $0.4689since 2016-07-01 | EAPG Weight Effective 7/1/2016 | — | Plans negotiate; applies out of network | — | EAPG Weights Version 3.10 |
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 169?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $1.52. New York pays the most ($8.00 per days (average length of stay)) and Virginia the least ($0.4689 per EAPG Weight Effective 7/1/2016).
Which state pays the highest Medicaid rate for 169?
New York, at $8.00 per days (average length of stay), effective 2018-07-01.
Do managed-care plans pay the same rate for 169?
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.