43855 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 5 state Medicaid programs publish a fee-for-service rate for 43855. Rates run from $45.00 in California to $1,343.87 in Maryland, with a median of $819.39.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $819.39units vary by state
- Highest
- $1,343.87Maryland
- Medicare (non-facility)
- —not on the physician fee schedule
43855 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 |
|---|---|---|---|---|---|---|
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $1,343.87since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $1,036.10since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Physician Maximum Allowed Fee Schedule - |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $819.39since 2021-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $793.60since 2010-02-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $45.00since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal UA and UB Modifier Maximum Allo |
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 43855?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $819.39. Maryland pays the most ($1,343.87) and California the least ($45.00).
Which state pays the highest Medicaid rate for 43855?
Maryland, at $1,343.87, effective 2026-01-01.
Do managed-care plans pay the same rate for 43855?
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.