969 Medicaid reimbursement rates by state
IHS / tribal outpatient visit (all-inclusive rate). 7 state Medicaid programs publish a fee-for-service rate for 969. Rates run from $6.12 in Oregon to $826.00 in Montana, with a median of $12.70.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $12.70units vary by state
- Highest
- $826.00Montana
- Medicare (non-facility)
- —not on the physician fee schedule
969 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 |
|---|---|---|---|---|---|---|
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid Indian Health Service and Tribal 638 facility rates (fee-for-service) | $826.00⚠ over 3× mediansince 2026-01-01 | — | — | Not classified | — | Indian Health Service Fee Schedule (July |
| 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) | $15.10since 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) | $12.70since 2026-09-24 | — | — | Plans must pay at least this | — | Medicaid DRG Weights V43 Grouper |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $9.43since 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) | $6.32since 2024-10-01 | — | — | Plans must pay at least this | — | DRG Data Table for 2024-10-01 Iowa Weigh |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $6.12since 2025-10-01 | Weights - 10% Cap Applied | — | Not classified | — | MS-DRG relative weights FY 2026 Final Ru |
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 969?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $12.70. Montana pays the most ($826.00) and Oregon the least ($6.12 per Weights - 10% Cap Applied).
Which state pays the highest Medicaid rate for 969?
Montana, at $826.00, effective 2026-01-01.
Do managed-care plans pay the same rate for 969?
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.