4001 Medicaid reimbursement rates by state
Outpatient hospital APC relative weight. 5 state Medicaid programs publish a fee-for-service rate for 4001. Rates run from $0.4544 in New York to $1.56 in Oregon, with a median of $1.40.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $1.40units vary by state
- Highest
- $1.56Oregon
- Medicare (non-facility)
- —not on the physician fee schedule
4001 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 |
|---|---|---|---|---|---|---|
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $1.56since 2025-01-01 | Relative Weight | — | Not classified | — | OPPS APC relative weights CY 2025 (CMS A |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $1.42since 2022-07-01 | Relative Weight | — | Plans negotiate; applies out of network | — | ASC EAPG Weights and Base Rate SFY 2023 |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service hospital rates | $1.40since 2022-07-01 | — | — | Plans must pay at least this | — | opps-weights-20220701.xlsx |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $0.9537since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $0.4544since 2026-01-01 | relative weight | — | Plans negotiate; applies out of network | — | NYS DOH APG-Based Weights History File ( |
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 4001?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $1.40. Oregon pays the most ($1.56 per Relative Weight) and New York the least ($0.4544 per relative weight).
Which state pays the highest Medicaid rate for 4001?
Oregon, at $1.56 per Relative Weight, effective 2025-01-01.
Do managed-care plans pay the same rate for 4001?
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.