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81254 Medicaid reimbursement rates by state

Clinical lab tests. 34 state Medicaid programs publish a fee-for-service rate for 81254 at the physician psychologist level. Rates run from $13.50 in Arizona to $98.40 in Georgia, with a median of $31.50.

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

States publishing
34
Median rate
$31.50units vary by state
Highest
$98.40Georgia
Medicare (non-facility)
—not on the physician fee schedule

81254 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
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$98.40⚠ over 3× mediansince 2017-01-01——Plans negotiate; applies out of network—Lab Max Allowable (in Zipped 2017 Fee Sc
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$52.65since 2013-01-01——Paid by the state, outside plans—KMAP Fee Schedule MKN Medicaid (FeeSched
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$44.89since 2025-03-26——Not classified—Arkansas Medicaid Independent Laboratory
TexasIndependent (non-agency) provider · Texas Medicaid (fee-for-service, TMHP)$37.80since 2019-07-04——Plans negotiate; applies out of network—TMHP Texas Medicaid Fee Schedule - Labor
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$35.00since 2018-01-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Medical-
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$35.00since 2018-04-15unit—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)$35.00since 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)$35.00since 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)$35.00since 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$35.00since 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)$35.00since 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)$35.00since 2019-12-01——Not classified—South Dakota Medicaid Laboratory fee sch
MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service)$34.99since 2018-07-01——Not classified—Montana Healthcare Programs fee schedule
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$34.13since 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)$33.58since 2024-02-01——Plans must pay at least this—Iowa Medicaid fee schedule #02 PHYSICIAN
MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service)$31.50since 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)$31.50since 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)$31.50since 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)$31.13since 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)$30.87since 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)$30.28since 2025-01-01——Plans negotiate; applies out of network—2026 Fee Schedule - Covered Procedures R
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$30.24since 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)$28.98since 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)$28.00since 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$28.00since 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)$28.00since 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)$27.83since 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)$27.30since 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)$26.25since 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)$24.50since 2018-01-01——Not classified—CMAP fee schedule: Lab October 2026
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$24.50since 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)$23.84since 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)$18.90since 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 81254?

It depends on the state. Of the 34 states with a published fee-for-service rate, the median is $31.50. Georgia pays the most ($98.40) and Arizona the least ($13.50 per A).

Which state pays the highest Medicaid rate for 81254?

Georgia, at $98.40, effective 2017-01-01.

Do managed-care plans pay the same rate for 81254?

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

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Medicaid rates by state
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