499 Medicaid reimbursement rates by state
Inpatient DRG pricing input (outlier, cost ratio, stay). 7 state Medicaid programs publish a fee-for-service rate for 499. Rates run from $0.0445 in Virginia to $2.90 in North Carolina, with a median of $0.2993.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $0.2993units vary by state
- Highest
- $2.90North Carolina
- Medicare (non-facility)
- —not on the physician fee schedule
499 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 |
|---|---|---|---|---|---|---|
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $2.90since 2026-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $2.01since 2025-10-01 | Weights - 10% Cap Applied | — | Not classified | — | MS-DRG relative weights FY 2026 Final Ru |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $1.16since 2024-10-01 | — | — | Plans must pay at least this | — | DRG Data Table for 2024-10-01 Iowa Weigh |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $0.2993since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $0.2533since 2026-01-01 | relative weight | — | Plans negotiate; applies out of network | — | NYS DOH APG-Based Weights History File ( |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $0.118since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $0.0445since 2022-07-01 | Relative Weight | — | Plans negotiate; applies out of network | — | ASC EAPG Weights and Base Rate SFY 2023 |
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 499?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $0.2993. North Carolina pays the most ($2.90) and Virginia the least ($0.0445 per Relative Weight).
Which state pays the highest Medicaid rate for 499?
North Carolina, at $2.90, effective 2026-10-01.
Do managed-care plans pay the same rate for 499?
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.