81235 Medicaid reimbursement rates by state
Clinical lab tests. 45 state Medicaid programs publish a fee-for-service rate for 81235 at the physician psychologist level. Rates run from $13.50 in Arizona to $389.50 in New Mexico, with a median of $280.76.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 45
- Median rate
- $280.76units vary by state
- Highest
- $389.50New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
81235 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) | $389.50since 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) | $350.54since 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) | $324.58since 2018-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $324.58since 2022-07-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $324.58since 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) | $324.58since 2018-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $324.58since 2018-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $324.58since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Clinical Lab fee schedule (2 |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $324.58since 2026-06-01 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| AlaskaPhysician or licensed psychologist (incl. BCBA-D) · Alaska Medicaid (fee-for-service, Department of Health) | $324.58since 2026-07-01 | — | — | Not classified | — | Alaska Medicaid Independent Laboratory F |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $324.58since 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) | $324.58since 2025-04-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $323.62since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $316.47since 2025-01-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - CPT Code |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $311.43since 2024-02-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $297.54since 2025-03-26 | — | — | Not classified | — | Arkansas Medicaid Independent Laboratory |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $295.37since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Laboratory' - |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $292.12since 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) | $292.12since 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) | $292.12since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | BMS CY 2023 Clinical Lab Fee Schedule (a |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $288.71since 2024-01-01 | — | — | Plans must pay at least this | — | SoonerCare Title XIX Fee Schedule |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $286.24since 2024-09-01 | — | — | Plans negotiate; applies out of network | — | Rates for Clinical Laboratory Services ( |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $280.76since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $280.51since 2014-04-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $280.44since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $275.89since 2025-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Laboratory and Radiol |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $270.38since 2026-07-01 | — | — | Not classified | — | Clinical Diagnostic Laboratory Test (CDL |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $268.75since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Clinical Laboratory Fee Schedule, |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $264.01since 2013-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $263.34since 2015-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $259.66since 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 | $259.66since 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) | $259.66since 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) | $258.04since 2026-02-01 | — | — | Not classified | — | Maryland Medicaid Medical Laboratory Fee |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $253.17since 2024-07-01 | — | — | Not classified | — | SCDHHS Independent Lab and Radiology Fee |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $243.44since 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) | $231.01since 2015-01-01 | — | — | Not classified | — | CMAP fee schedule: Lab October 2026 |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $231.01since 2016-07-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $221.08since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $188.10since 2014-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $180.00since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $165.01since 2023-10-01 | — | — | Plans negotiate; applies out of network | — | Provider Type 43, Laboratory, Pathology |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $106.92since 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) | $98.40since 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 81235?
It depends on the state. Of the 45 states with a published fee-for-service rate, the median is $280.76. New Mexico pays the most ($389.50) and Arizona the least ($13.50 per A).
Which state pays the highest Medicaid rate for 81235?
New Mexico, at $389.50, effective 2024-11-01.
Do managed-care plans pay the same rate for 81235?
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.
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Track 81235 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.