81558 Medicaid reimbursement rates by state
Clinical lab tests. 21 state Medicaid programs publish a fee-for-service rate for 81558 at the independent level. Rates run from $262.99 in New Mexico to $3,240.00 in Montana, with a median of $2,754.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 21
- Median rate
- $2,754.00units vary by state
- Highest
- $3,240.00Montana
- Medicare (non-facility)
- —not on the physician fee schedule
81558 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 |
|---|---|---|---|---|---|---|
| MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service) | $3,240.00since 2025-01-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $3,240.00since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Clinical |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $3,240.00since 2025-01-01 | 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) | $3,240.00since 2025-01-01 | — | — | 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 | $3,240.00since 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) | $3,240.00since 2025-01-01 | — | — | Not classified | — | South Dakota Medicaid Laboratory fee sch |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $3,175.20since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2025 Physician Fee Schedule |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $2,916.00since 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) | $2,916.00since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $2,851.20since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $2,754.00since 2025-01-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $2,592.00since 2026-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $2,592.00since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $2,592.00since 2025-04-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $2,575.80since 2026-02-01 | — | — | Not classified | — | Maryland Medicaid Medical Laboratory Fee |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $2,430.00since 2025-04-01 | — | — | 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) | $2,268.00since 2025-01-01 | — | — | Not classified | — | CMAP fee schedule: Lab October 2026 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $2,206.76since 2025-01-01 | — | — | 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) | $1,749.60since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Independent Laboratory Fee Schedule (202 |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $972.00since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $262.99since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
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 81558?
It depends on the state. Of the 21 states with a published fee-for-service rate, the median is $2,754.00. Montana pays the most ($3,240.00) and New Mexico the least ($262.99).
Which state pays the highest Medicaid rate for 81558?
Montana, at $3,240.00, effective 2025-01-01.
Do managed-care plans pay the same rate for 81558?
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 81558 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.