G0323 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for G0323, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 3 of the 8 states list more than one rate for G0323, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 8 states, 1 publish G0323 per per calendar month, and 7 schedules print no unit at all (a flat amount per service).
• Per hour. G0323 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. Medicare amounts exist for G0323, but no state's Medicaid unit matches Medicare's billing unit closely enough to compute a percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for G0323 run from $33.16 in Michigan to $81.22 in Montana, a 2.4x gap in the same unit. Half the states pay more than the median of $42.50 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• Modifiers such as professional or technical component, bilateral, multiple procedure and assistant at surgery change the amount paid, and states apply them with their own percentages.
• Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.
• Primary-care and pediatric add-ons, enhanced rates for certain specialties and targeted increases for access problems change individual codes without moving the rest of the schedule.

Timing matters too. 5 states set the current rate for G0323 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

No managed-care plan publishes what it pays for G0323. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 3 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 2 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 2 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 1 state is not classified yet.

• Plans must pay at least the published rate (3 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Plans negotiate; the published rate applies out of network (2 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• State-directed payment (1 state). Eligible providers receive the directed amount on top of, or as a floor under, negotiated rates. Check whether your provider class qualifies.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Montana managed care.

G0323 is a HCPCS Level II professional services code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. G codes describe professional services and procedures that have no CPT code, or that payers define more narrowly. Many are timed, so check the unit before comparing.

Physician-fee-schedule codes are billed per service: one unit is one occurrence unless the code itself is defined by time or quantity. Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead.

Medicare's 2026 physician fee schedule pays $54.25–$71.80 for G0323 (non-facility), depending on the Medicare locality. That is a useful reference point, but Medicare and Medicaid can define the unit differently, so compare only where the units match.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.