86769 Medicaid reimbursement rates by state
Clinical lab tests. 33 state Medicaid programs publish a fee-for-service rate for 86769 at the physician psychologist level. Rates run from $11.16 in Pennsylvania to $51.31 in Georgia, with a median of $37.92.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 33
- Median rate
- $37.92units vary by state
- Highest
- $51.31Georgia
- Medicare (non-facility)
- —not on the physician fee schedule
86769 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 |
|---|---|---|---|---|---|---|
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $51.31since 2020-07-01 | — | — | Plans negotiate; applies out of network | — | Lab Max Allowable (in Zipped Fee Schedul |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $45.50since 2019-07-04 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $44.10since 2023-07-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $42.13since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Clinical |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $42.13since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $42.13since 2024-09-01 | — | — | Plans negotiate; applies out of network | — | Rates for Clinical Laboratory Services ( |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $42.13since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Laboratory' - |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $42.13since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $42.13since 2020-05-19 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $42.13since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $42.13since 2020-08-10 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $42.13since 2020-04-10 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $42.13since 2026-02-01 | — | — | Not classified | — | Maryland Medicaid Medical Laboratory Fee |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $42.13since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Clinical Lab fee schedule (2 |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $40.42since 2024-02-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $37.92since 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) | $37.92since 2022-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, May 2023 |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $37.47since 2024-10-01 | — | — | Plans must pay at least this | — | SoonerCare Title XIX Fee Schedule |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $35.81since 2025-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Laboratory and Radiol |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $35.81since 2020-04-10 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $35.09since 2026-07-01 | — | — | Not classified | — | Clinical Diagnostic Laboratory Test (CDL |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $34.89since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $33.70since 2022-12-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing Outpatie |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $33.70since 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) | $33.70since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $32.86since 2024-10-01 | — | — | Not classified | — | SCDHHS Independent Lab and Radiology Fee |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $31.60since 2025-04-01 | — | — | Plans negotiate; applies out of network | — | ODM laboratory services payment schedule |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $29.49since 2026-04-10 | — | — | Not classified | — | Laboratory and Radiology Fee Schedule (R |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $29.49since 2024-10-01 | — | — | Not classified | — | CMAP fee schedule: Lab October 2026 |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $25.28since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Laboratory Fee Sched |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $21.07since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | Provider Type 43, Laboratory, Pathology |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $15.60since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Independent Laboratory Fee Schedule (202 |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $11.16since 2020-04-10 | — | — | 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 86769?
It depends on the state. Of the 33 states with a published fee-for-service rate, the median is $37.92. Georgia pays the most ($51.31) and Pennsylvania the least ($11.16).
Which state pays the highest Medicaid rate for 86769?
Georgia, at $51.31, effective 2020-07-01.
Do managed-care plans pay the same rate for 86769?
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 86769 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.