86490 Medicaid reimbursement rates by state
Clinical lab tests. 7 state Medicaid programs publish a fee-for-service rate for 86490 at the physician psychologist level. Rates run from $5.14 in North Carolina to $71.31 in New Mexico, with a median of $10.37.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $10.37units vary by state
- Highest
- $71.31New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
86490 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) | $71.31⚠ over 3× mediansince 2023-07-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $62.34⚠ over 3× mediansince 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $48.78⚠ over 3× mediansince 2024-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Clinical Laboratory Fee Schedule, |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $10.37since 2018-10-01 | — | — | Plans negotiate; applies out of network | — | Lab Max Allowable (in Zipped 2018 Fee Sc |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $9.00since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Nurse Practitioner Fee |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $8.44since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2024-2025 Rate |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $5.14since 2022-01-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Physician Serv |
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 86490?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $10.37. New Mexico pays the most ($71.31) and North Carolina the least ($5.14).
Which state pays the highest Medicaid rate for 86490?
New Mexico, at $71.31, effective 2023-07-01.
Do managed-care plans pay the same rate for 86490?
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.