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Billing code 86053 · Lab & pathology

86053 Medicaid reimbursement rate by state (2026)

Clinical lab tests. Medicaid pays a median of $30.18 for 86053 across 42 states, from $6.02 in Nevada to $40.74 in Texas.

Data as of Oct 5, 202642 statesEvery rate links to its official source

States publishing
42
National median
$30.18units vary by state
Lowest
$6.02Nevada
Highest
$40.74Texas
Answer

What does Medicaid pay for 86053?

42 state Medicaid programs publish a fee-for-service rate for 86053. The national median is $30.18 (units differ between states). Texas pays the most, $40.74, and Nevada the least, $6.02, a 6.8x spread.

State ranking

86053 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 42 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Texas Source · since 2024-03-15$40.74——Plans negotiate; applies out of network—
2Arizona Source · since 2024-01-01$37.73——Plans negotiate; applies out of network—
3Indiana Source · since 2024-01-01$37.73unit—Plans must pay at least this—
21New Jersey Source · since 2024-12-01$30.18——Not classified—
22Washington Source · since 2026-01-01$30.18——Plans may pay no more—
23District of Columbia Source · since 2023-04-01$30.18——Not classified—
41Florida Source · since 2026-01-01$6.17——Plans negotiate; applies out of network—
42Nevada Source · since 2022-01-01$6.02——Plans negotiate; applies out of network—
See all 42 states for 86053 — start free

34 more states, with every modifier and provider-type variant, rate history and the plan rule in each state. 14-day free trial, no credit card.

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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; states with several Medicare localities show a range. Confirm rates with the payer before billing.

Track 86053 in your states. Get an alert when any state changes it, with every variant and the managed-care rule.
FAQ

Frequently asked questions

What does Medicaid pay for 86053?

It depends on the state. Of the 42 states with a published fee-for-service rate, the median is $30.18. Texas pays the most ($40.74) and Nevada the least ($6.02).

Which state pays the highest Medicaid rate for 86053?

Texas, at $40.74, effective 2024-03-15.

Do managed-care plans pay the same rate for 86053?

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 workspace shows the rule for each state, cited to the contract or statute.