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81242 Medicaid reimbursement rates by state

Clinical lab tests. 36 state Medicaid programs publish a fee-for-service rate for 81242 at the physician psychologist level. Rates run from $13.50 in Arizona to $112.38 in Kansas, with a median of $33.14.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
36
Median rate
$33.14units vary by state
Highest
$112.38Kansas
Medicare (non-facility)
—not on the physician fee schedule

81242 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.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$112.38⚠ over 3× mediansince 2013-01-01——Paid by the state, outside plans—KMAP Fee Schedule MKN Medicaid (FeeSched
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
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$87.55since 2025-03-26——Not classified—Arkansas Medicaid Independent Laboratory
TexasIndependent (non-agency) provider · Texas Medicaid (fee-for-service, TMHP)$39.54since 2019-07-04——Plans negotiate; applies out of network—TMHP Texas Medicaid Fee Schedule - Labor
Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service)$36.62since 2024-01-01——Plans negotiate; applies out of network—RI Medicaid Interactive Fee For Service
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$36.62since 2018-01-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Medical-
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$36.62since 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)$36.62since 2024-07-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$36.62since 2019-01-01——Plans negotiate; applies out of network—DMAS procedure fee file cptmedical4.csv
KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules)$36.62since 2020-01-01——Plans negotiate; applies out of network—KY Medicaid Clinical Lab fee schedule (2
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$36.62since 2024-11-01——Plans must pay at least this—New Mexico Medicaid Fee for Service CPT
HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service$36.62since 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)$36.62since 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)$36.62since 2019-12-01——Not classified—South Dakota Medicaid Laboratory fee sch
MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service)$36.61since 2018-07-01——Not classified—Montana Healthcare Programs fee schedule
UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan)$36.51since 2026-07-01——Plans negotiate; applies out of network—Utah Medicaid Coverage and Reimbursement
DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP)$35.89since 2024-01-01——Plans negotiate; applies out of network—DMAP 2024 Physician Fee Schedule
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$33.32since 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)$32.96since 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)$32.96since 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)$32.96since 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)$32.57since 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)$32.29since 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)$31.64since 2025-09-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju
ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service)$30.50since 2026-07-01——Not classified—Clinical Diagnostic Laboratory Test (CDL
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$30.32since 2023-01-01——Plans negotiate; applies out of network—MDHHS Clinical Laboratory Fee Schedule,
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$29.30since 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$29.30since 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)$29.30since 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)$29.11since 2026-02-01——Not classified—Maryland Medicaid Medical Laboratory Fee
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$27.47since 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)$25.63since 2018-01-01——Not classified—CMAP fee schedule: Lab October 2026
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$25.63since 2018-01-01——Not classified—MaineCare Fee Schedule (MaineCare UCR, H
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$24.94since 2024-04-01——Plans negotiate; applies out of network—HFS Practitioner Fee Schedule (effective
FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service)$19.77since 2026-01-01——Plans negotiate; applies out of network—Independent Laboratory Fee Schedule (202
ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$13.50since 2021-10-01A—Plans negotiate; applies out of network—AHCCCS Arizona Health Care Cost Containm

Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 81242?

It depends on the state. Of the 36 states with a published fee-for-service rate, the median is $33.14. Kansas pays the most ($112.38) and Arizona the least ($13.50 per A).

Which state pays the highest Medicaid rate for 81242?

Kansas, at $112.38, effective 2013-01-01.

Do managed-care plans pay the same rate for 81242?

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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Medicaid rates by state
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