81227 Medicaid reimbursement rates by state
Clinical lab tests. 29 state Medicaid programs publish a fee-for-service rate for 81227 at the independent level. Rates run from $13.50 in Arizona to $209.77 in New Mexico, with a median of $144.74.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 29
- Median rate
- $144.74units vary by state
- Highest
- $209.77New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
81227 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 MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $209.77since 2024-11-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| TexasIndependent (non-agency) provider · Texas Medicaid (fee-for-service, TMHP) | $188.79since 2019-07-04 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Labor |
| MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service) | $174.81since 2018-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $174.81since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $174.81since 2024-07-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $174.81since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Clinical Lab fee schedule (2 |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $174.81since 2019-12-01 | — | — | Not classified | — | South Dakota Medicaid Laboratory fee sch |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $174.81since 2025-04-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| IowaIndependent (non-agency) provider · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $166.07since 2024-09-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #10 INDEPENDE |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $157.33since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Independent L |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $157.33since 2022-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, May 2023 |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $157.33since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | BMS CY 2024 Clinical Lab Fee Schedule |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $154.16since 2024-09-01 | — | — | Plans negotiate; applies out of network | — | Rates for Clinical Laboratory Services ( |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $151.04since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $144.74since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Clinical Laboratory Fee Schedule, |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $141.71since 2014-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $139.85since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $139.85since 2026-01-01 | — | — | Plans may pay no more | — | HCA Physician-related services fee sched |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $139.85since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $138.97since 2026-02-01 | — | — | Not classified | — | Maryland Medicaid Medical Laboratory Fee |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $135.60since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $131.11since 2019-04-01 | — | — | Plans negotiate; applies out of network | — | ODM laboratory services payment schedule |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $122.56since 2015-01-01 | — | — | Not classified | — | CMAP fee schedule: Lab October 2026 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $119.07since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $106.05since 2020-05-29 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Laboratory Fee Sched |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $100.06since 2025-03-26 | — | — | Not classified | — | Arkansas Medicaid Independent Laboratory |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $49.42since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Independent Laboratory Fee Schedule (202 |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $40.00since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Lab Max Allowable (in Zipped 2017 Fee Sc |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $13.50since 2021-10-01 | A | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
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 81227?
It depends on the state. Of the 29 states with a published fee-for-service rate, the median is $144.74. New Mexico pays the most ($209.77) and Arizona the least ($13.50 per A).
Which state pays the highest Medicaid rate for 81227?
New Mexico, at $209.77, effective 2024-11-01.
Do managed-care plans pay the same rate for 81227?
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.
Related Lab & pathology codes
80051Clinical lab tests · 48 states80053Clinical lab tests · 48 states80061Clinical lab tests · 48 states80069Clinical lab tests · 48 states80076Clinical lab tests · 48 states80150Clinical lab tests · 48 states80156Clinical lab tests · 48 states80157Clinical lab tests · 48 states80158Clinical lab tests · 48 states80159Clinical lab tests · 48 states80162Clinical lab tests · 48 states80164Clinical lab tests · 48 states
Track 81227 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.