81263 Medicaid reimbursement rates by state
Clinical lab tests. 32 state Medicaid programs publish a fee-for-service rate for 81263 at the physician psychologist level. Rates run from $13.50 in Arizona to $353.43 in New Mexico, with a median of $273.16.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 32
- Median rate
- $273.16units vary by state
- Highest
- $353.43New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
81263 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) | $353.43since 2024-11-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $341.52since 2014-04-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $320.63since 2015-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $318.08since 2021-11-17 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service) | $294.52since 2020-01-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $294.52since 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) | $294.52since 2020-01-01 | — | — | 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) | $294.52since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $294.52since 2020-01-01 | — | — | 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) | $294.52since 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 | $294.52since 2026-06-01 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $294.52since 2020-01-01 | — | — | Not classified | — | South Dakota Medicaid Laboratory fee sch |
| North DakotaAny qualified provider (rate does not vary by provider) · North Dakota Medicaid (fee-for-service) | $294.52since 2025-01-01 | — | — | Not classified | — | ND Medicaid Professional Services Fee Sc |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $289.06since 2026-02-01 | — | — | Not classified | — | Maryland Medicaid Medical Laboratory Fee |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $281.25since 2015-01-01 | — | — | Not classified | — | CMAP fee schedule: Lab October 2026 |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $281.25since 2025-01-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $265.07since 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) | $265.07since 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) | $265.07since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | BMS CY 2023 Clinical Lab Fee Schedule (a |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $259.73since 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) | $254.47since 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) | $243.86since 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) | $235.62since 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 | $235.62since 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) | $235.62since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $220.89since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | ODM laboratory services payment schedule |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $217.30since 2014-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $200.59since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $193.38since 2025-03-26 | — | — | Not classified | — | Arkansas Medicaid Independent Laboratory |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $110.50since 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 81263?
It depends on the state. Of the 32 states with a published fee-for-service rate, the median is $273.16. New Mexico pays the most ($353.43) and Arizona the least ($13.50 per A).
Which state pays the highest Medicaid rate for 81263?
New Mexico, at $353.43, effective 2024-11-01.
Do managed-care plans pay the same rate for 81263?
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 · 50 states80053Clinical lab tests · 50 states80061Clinical lab tests · 50 states80069Clinical lab tests · 50 states80076Clinical lab tests · 50 states80150Clinical lab tests · 50 states80156Clinical lab tests · 50 states80157Clinical lab tests · 50 states80158Clinical lab tests · 50 states80159Clinical lab tests · 50 states80162Clinical lab tests · 50 states80164Clinical lab tests · 50 states
Track 81263 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.