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Billing code 81201 · Lab & pathology

81201 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $693.80 for 81201 across 43 states, from $13.50 in Arizona to $914.69 in Pennsylvania.

Data as of Oct 5, 202643 statesEvery rate links to its official source

States publishing
43
National median
$693.80units vary by state
Lowest
$13.50Arizona
Highest
$914.69Pennsylvania
Answer

What does Medicaid pay for 81201?

43 state Medicaid programs publish a fee-for-service rate for 81201. The national median is $693.80 (units differ between states). Pennsylvania pays the most, $914.69, and Arizona the least, $13.50 per A, a 67.8x spread.

State ranking

81201 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 43 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Pennsylvania Source · since 2014-06-23$914.69——Plans negotiate; applies out of network—
2Texas Source · since 2019-07-04$842.40——Plans negotiate; applies out of network—
3Montana Source · since 2018-07-01$780.00——Not classified—
21West Virginia Source · since 2023-04-01$702.00——Plans negotiate; applies out of network—
22Oklahoma Source · since 2024-01-01$693.80——Plans must pay at least this—
23Massachusetts Source · since 2024-09-01$687.86——Plans negotiate; applies out of network—
42Georgia Source · since 2017-01-01$98.40——Plans negotiate; applies out of network—
43Arizona Source · since 2021-10-01$13.50A—Plans negotiate; applies out of network—
See all 43 states for 81201 — start free

35 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 81201 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 81201?

It depends on the state. Of the 43 states with a published fee-for-service rate, the median is $693.80. Pennsylvania pays the most ($914.69) and Arizona the least ($13.50 per A).

Which state pays the highest Medicaid rate for 81201?

Pennsylvania, at $914.69, effective 2014-06-23.

Do managed-care plans pay the same rate for 81201?

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.