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Billing code 365 · Hospital outpatient

365 Medicaid reimbursement rate by state (2026)

APG relative weight. Medicaid pays a median of $0.4259 for 365 across 5 states, from $0.3297 in Illinois to $1.12 in New York.

Data as of Oct 5, 20265 statesEvery rate links to its official source

States publishing
5
National median
$0.4259units vary by state
Lowest
$0.3297Illinois
Highest
$1.12New York
Answer

What does Medicaid pay for 365?

5 state Medicaid programs publish a fee-for-service rate for 365. The national median is $0.4259 (units differ between states). New York pays the most, $1.12 per relative weight, and Illinois the least, $0.3297, a 3.4x spread.

State ranking

365 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 5 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1New York Source · since 2026-01-01$1.12relative weight—Plans negotiate; applies out of network—
2Wisconsin Source · since 2026-01-01$0.9051——Plans negotiate; applies out of network—
3Virginia Source · since 2019-07-01$0.4259EAPG WEIGHT—Plans negotiate; applies out of network—
See all 5 states for 365 — start free

2 more states, with every modifier and provider-type variant, rate history and the plan rule in each state. 14-day free trial, no credit card.

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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; states with several Medicare localities show a range. Confirm rates with the payer before billing.

Track 365 in your states. Get an alert when any state changes it, with every variant and the managed-care rule.
FAQ

Frequently asked questions

What does Medicaid pay for 365?

It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $0.4259. New York pays the most ($1.12 per relative weight) and Illinois the least ($0.3297).

Which state pays the highest Medicaid rate for 365?

New York, at $1.12 per relative weight, effective 2026-01-01.

Do managed-care plans pay the same rate for 365?

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 workspace shows the rule for each state, cited to the contract or statute.