869 Medicaid reimbursement rates by state
Inpatient DRG pricing input (outlier, cost ratio, stay). 13 state Medicaid programs publish a fee-for-service rate for 869. Rates run from $0.1832 in Illinois to $1,277.27 in New Hampshire, with a median of $0.6774.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 13
- Median rate
- $0.6774units vary by state
- Highest
- $1,277.27New Hampshire
- Medicare (non-facility)
- —not on the physician fee schedule
869 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 HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $1,277.27⚠ over 3× mediansince 2025-10-01 | — | — | Plans must pay at least this | — | DRG Relative Weight Price Report General |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid (KMAP fee-for-service schedule) | $78.00⚠ over 3× mediansince 2023-01-01 | — | — | Plans must pay at least this | — | KMAP Hospital Fee-for-Service Provider M |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $2.50⚠ over 3× mediansince 2026-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Grouper DRG We |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $1.31since 2026-09-24 | — | — | Plans must pay at least this | — | Medicaid DRG Weights V43 Grouper |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $0.7403since 2026-01-01 | relative weight | — | Plans negotiate; applies out of network | — | NYS DOH APG-Based Weights History File ( |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $0.7297since 2025-10-01 | Weights - 10% Cap Applied | — | Not classified | — | MS-DRG relative weights FY 2026 Final Ru |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $0.6774since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | West Virginia Rate Year 2026 DRG Paramet |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $0.587since 2024-10-01 | — | — | Plans must pay at least this | — | DRG Data Table for 2024-10-01 Iowa Weigh |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $0.5868since 2025-10-01 | — | — | Not classified | — | DVHA Relative Weights Effective 10/1/202 |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $0.4443since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth Rate Year 2026 EAPG weight |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $0.2156since 2024-07-01 | EAPG WEIGHT | — | Plans negotiate; applies out of network | — | EAPG Weights Version 3.18 |
| District of ColumbiaAny qualified provider (rate does not vary by provider) · DC Medicaid FFS (hospital) | $0.2156since 2024-10-01 | — | — | Plans must pay at least this | — | DC EAPG Relative Weights FY2026 (DCO2500 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $0.1832since 2023-08-01 | — | — | Plans negotiate; applies out of network | — | Outpatient Calculator Effective August 1 |
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 869?
It depends on the state. Of the 13 states with a published fee-for-service rate, the median is $0.6774. New Hampshire pays the most ($1,277.27) and Illinois the least ($0.1832).
Which state pays the highest Medicaid rate for 869?
New Hampshire, at $1,277.27, effective 2025-10-01.
Do managed-care plans pay the same rate for 869?
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.