G9874 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 G9874, 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. 1 of the 5 states list more than one rate for G9874, 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. None of the 5 schedules prints a separate unit for G9874, so each amount is a flat payment for one service as the code defines it.
• Per hour. G9874 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. No Medicare physician fee schedule amount is on file for G9874, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for G9874 run from $18.53 in Wyoming to $150.00 in Illinois, a 8.1x gap in the same unit. Half the states pay more than the median of $44.93 and half pay less. The usual reasons for a spread like this in other rates:

• Some states tie their rates to a percentage of a Medicare amount; others keep a schedule of their own that changes only when the legislature funds an increase.
• Rate studies, settlements and targeted increases for workforce shortages move individual services out of step with the rest of a state's schedule.
• States pay different amounts by provider type, setting and program, and the published rate may already include or exclude add-ons that another state pays separately.

Timing matters too. 1 state set the current rate for G9874 in 2026 or later, while 2 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For G9874, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 3 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 2 states is not classified yet.

• Plans negotiate; the published rate applies out of network (3 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.

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 Illinois managed care.

G9874 is a HCPCS Level II professional services code in the other line, billed mostly by providers. 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.

This service is billed in the unit the state's schedule defines.

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.