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85097 Medicaid reimbursement rates by state

Clinical lab tests. 45 state Medicaid programs publish a fee-for-service rate for 85097 at the physician psychologist level. Rates run from $19.20 in Pennsylvania to $104.59 in Delaware, with a median of $44.95.

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

States publishing
45
Median rate
$44.95units vary by state
Highest
$104.59Delaware
Medicare (non-facility)
$62.00–$86.062026 physician fee schedule

85097 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
DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP)$104.59since 2024-01-01——Plans negotiate; applies out of network—DMAP 2024 Physician Fee Schedule
MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service)$95.31since 2026-07-01——Not classified—Montana Healthcare Programs fee schedule
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$79.01since 2023-07-01——Plans must pay at least this—New Mexico Medicaid Fee for Service CPT
MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH)$71.28since 2026-06-01——Not classified—Maryland Medicaid Medical Laboratory Fee
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$67.65since 2026-01-01——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)$66.01since 2020-01-01——Plans negotiate; applies out of network—KY Medicaid Physician fee schedule (2020
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$63.47since 2023-07-01——Paid by the state, outside plans—KMAP Fee Schedule MKN Medicaid (FeeSched
LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service)$62.88since 2026-01-01——Plans must pay at least this—Louisiana Medicaid Enhanced Professional
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$59.59since 2026-07-01——Plans must pay at least this—SoonerCare Title XIX Fee Schedule
MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service)$59.50since 2026-07-01——Plans must pay at least this—MO HealthNet fee schedule: Independent L
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$57.50since 2026-07-01——Plans negotiate; applies out of network—Nebraska Medicaid fee schedule 471-000-5
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$56.73since 2026-01-01——Not classified—Vermont Medicaid Fee Schedule - CPT Code
MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service)$56.21since 2026-07-01——Plans must pay at least this—DOM Comprehensive Fee Schedule, Septembe
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$55.79since 2016-01-02——Not classified—MaineCare Fee Schedule (MaineCare UCR, H
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$55.74since 2026-01-01——Not classified—CMAP fee schedule: Physician Office and
TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP)$55.60since 2025-09-01——Plans negotiate; applies out of network—TMHP Texas Medicaid Fee Schedule - Physi
OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA)$54.63since 2026-02-01——Plans negotiate; applies out of network—OHP FFS medical-dental fee schedule (fee
UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan)$51.89since 2010-07-01——Plans negotiate; applies out of network—Utah Medicaid Coverage and Reimbursement
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$50.47since 2024-07-01——Not classified—SCDHHS Base Physician Fee Schedule (sche
IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$50.23since 2013-07-01——Plans must pay at least this—Iowa Medicaid fee schedule #02 PHYSICIAN
HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service$46.74since 2026-06-01——Plans negotiate; applies out of network—Medicaid Fee-For-Service (FFS) Fee Sched
West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services)$46.12since 2026-04-01——Plans negotiate; applies out of network—BMS RBRVS 2026 Effective 4/1/26 - 3/31/2
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$44.95since 2019-10-01——Plans negotiate; applies out of network—OutPatient Fee Schedule - Site of Servic
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$44.82since 2025-01-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules)$44.68since 2017-01-01——Plans negotiate; applies out of network—Provider Type 43, Laboratory, Pathology
AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules)$43.91since 2026-04-10——Not classified—Laboratory and Radiology Fee Schedule (R
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$43.56since 2026-01-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$43.24since 2026-01-01——Plans negotiate; applies out of network—MDHHS Clinical Laboratory Fee Schedule,
FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service)$42.50since 2026-01-01——Plans negotiate; applies out of network—Practitioner Laboratory Fee Schedule (20
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$41.80since 2025-03-26——Not classified—Arkansas Medicaid Independent Laboratory
WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service$41.09since 2026-07-01——Plans negotiate; applies out of network—HCA Kidney centers fee schedule (kidneyc
ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$41.07since 2026-10-01——Plans negotiate; applies out of network—AHCCCS Arizona Health Care Cost Containm
ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP)$38.97since 2026-07-01——Plans negotiate; applies out of network—Child Health Plan Plus FY 2026-2027 Fee
North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service)$37.87since 2025-10-01——Plans must pay at least this—NC Medicaid fee schedule 'Physician Serv
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$37.64since 2026-01-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Medical-
MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations)$35.33since 2026-10-01——Plans negotiate; applies out of network—Emergency Adoption (date filed: Septembe
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$35.25since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$34.88since 2025-04-01——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)$33.85since 2026-07-01——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)$31.05since 2024-04-01——Plans negotiate; applies out of network—HFS Practitioner Fee Schedule (effective
Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service)$30.96since 1993-04-01——Plans negotiate; applies out of network—RI Medicaid Interactive Fee For Service
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$28.89since 2025-09-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju
New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS)$26.28since 2023-07-01——Plans negotiate; applies out of network—2026 Fee Schedule - Covered Procedures R
New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service)$20.42since 2020-05-29——Plans negotiate; applies out of network—eMedNY NYS Medicaid Laboratory Fee Sched
PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service)$19.20since 2009-04-01——Plans negotiate; applies out of network—PA DHS PROMISe Outpatient Fee Schedule (

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 85097?

It depends on the state. Of the 45 states with a published fee-for-service rate, the median is $44.95. Delaware pays the most ($104.59) and Pennsylvania the least ($19.20).

Which state pays the highest Medicaid rate for 85097?

Delaware, at $104.59, effective 2024-01-01.

Do managed-care plans pay the same rate for 85097?

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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