4011 Medicaid reimbursement rates by state
FQHC / RHC visit (PPS or APM rate). 6 state Medicaid programs publish a fee-for-service rate for 4011. Rates run from $0.5196 in Illinois to $43.96 in New York, with a median of $1.17.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $1.17units vary by state
- Highest
- $43.96New York
- Medicare (non-facility)
- —not on the physician fee schedule
4011 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) | $43.96since 2025-10-01 | visit | — | State wraparound guarantee | — | NYS DOH FQHC rates by provider (posted 9 |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $2.39since 2025-01-01 | Relative Weight | — | Not classified | — | OPPS APC relative weights CY 2025 (CMS A |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $1.34since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $1.00since 2026-07-01 | factor | — | Plans expected to pay at least this | — | Florida Medicaid DRG Rate Worksheet SFY |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $0.6293since 2024-07-01 | Relative Weight | — | Plans negotiate; applies out of network | — | ASC EAPG Weights and Base Rate SFY 2025 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $0.5196since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
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 4011?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $1.17. New York pays the most ($43.96 per visit) and Illinois the least ($0.5196).
Which state pays the highest Medicaid rate for 4011?
New York, at $43.96 per visit, effective 2025-10-01.
Do managed-care plans pay the same rate for 4011?
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.