A4221 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 A4221, 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. 17 of the 43 states list more than one rate for A4221, 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 43 states, 1 publish A4221 per week and 1 per set, and 41 schedules print no unit at all (a flat amount per service).
• Per hour. A4221 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 A4221, 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 A4221 run from $16.61 in Texas to $38.66 in North Dakota, a 2.3x gap in the same unit. Half the states pay more than the median of $22.62 and half pay less. The usual reasons for a spread like this in equipment & supplies rates:

• A single code can carry separate purchase, rental and used-equipment amounts, and states publish different subsets of them.
• Some items are priced individually from the manufacturer's price or the supplier's invoice, so fewer states publish a fixed fee.
• Many states set equipment and supply fees as a percentage of the Medicare DMEPOS fee schedule, at different percentages and from different years.

Timing matters too. 24 states set the current rate for A4221 in 2026 or later, while 11 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.

No managed-care plan publishes what it pays for A4221. 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 8 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 19 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 16 states is not classified yet.

• Plans negotiate; the published rate applies out of network (19 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.
• Plans must pay at least the published rate (7 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.
• The state sets the plan rate (1 state). There is little to negotiate on price. Contracting is about network participation, authorization and billing terms.

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 North Dakota managed care.

A4221 is a HCPCS Level II transportation and supply code in the equipment & supplies line, billed mostly by durable medical equipment suppliers, orthotists, prosthetists and pharmacies. A codes cover ambulance and transportation services and medical and surgical supplies. Transport codes are paid per trip or per mile; supply codes per item or per box as the code states.

Units follow the code: per item, per pair, per box or per month of rental, so a per-unit comparison only holds when the states use the same unit. Pricing modifiers decide which amount applies: NU for a new purchase, RR for a monthly rental and UE for used equipment.

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.