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Billing code 55860 · Physician & professional

55860 Medicaid reimbursement rate by state (2026)

Physician and practitioner services (fee schedule). Medicaid pays a median of $670.28 for 55860 across 48 states, from $9.30 in New Jersey to $1,368.65 in Alabama.

Data as of Oct 5, 202648 statesEvery rate links to its official source

States publishing
48
National median
$670.28units vary by state
Lowest
$9.30New Jersey
Highest
$1,368.65Alabama
Answer

What does Medicaid pay for 55860?

48 state Medicaid programs publish a fee-for-service rate for 55860. The national median is $670.28 (units differ between states). Alabama pays the most, $1,368.65, and New Jersey the least, $9.30 per base unit, a 147.2x spread.

State ranking

55860 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 48 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Alabama Source · since 2026-09-24$1,368.65——Not classified—
2New Mexico Source · since 2025-01-01$1,259.13——Plans must pay at least this—
3Montana Source · since 2026-07-01$1,104.55——Not classified—
24Utah Source · since 2026-07-01$674.28——Plans negotiate; applies out of network—
25Mississippi Source · since 2026-07-01$666.27——Plans must pay at least this—
26Massachusetts Source · since 2026-10-01$641.70——Plans negotiate; applies out of network—
47Rhode Island Source · since 1996-01-01$111.46——Plans negotiate; applies out of network—
48New Jersey Source · since 2014-07-01$9.30base unit—Not classified—
See all 48 states for 55860 — start free

40 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 55860 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 55860?

It depends on the state. Of the 48 states with a published fee-for-service rate, the median is $670.28. Alabama pays the most ($1,368.65) and New Jersey the least ($9.30 per base unit).

Which state pays the highest Medicaid rate for 55860?

Alabama, at $1,368.65, effective 2026-09-24.

Do managed-care plans pay the same rate for 55860?

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.