A4264 Medicaid reimbursement rates by state
Permanent implantable contraceptive intratubal occlusion.... 13 state Medicaid programs publish a fee-for-service rate for A4264 at the physician psychologist level. Rates run from $383.06 in Connecticut to $1,754.83 in Colorado, with a median of $1,400.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 13
- Median rate
- $1,400.00units vary by state
- Highest
- $1,754.83Colorado
- Medicare (non-facility)
- —not on the physician fee schedule
A4264 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 |
|---|---|---|---|---|---|---|
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,754.83since 2023-01-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $1,674.00since 2012-06-01 | — | — | Not classified | — | SCDHHS Pediatric Subspecialty and Neonat |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $1,560.00since 2017-04-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| UtahPhysician or licensed psychologist (incl. BCBA-D) · Utah Medicaid (fee-for-service, Traditional plan) | $1,507.68since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $1,500.00since 2020-08-01 | — | — | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $1,499.89since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $1,400.00since 2025-04-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $1,400.00since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2020 |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $1,400.00since 2012-11-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $1,307.25since 2024-01-01 | — | — | Plans must pay at least this | — | Provider Type 20 Physician, MD., Osteopa |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $1,300.00since 2011-01-03 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $1,299.00since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $383.06since 2026-07-04 | — | — | Not classified | — | CMAP fee schedule: Clinic - Family Plann |
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 A4264?
It depends on the state. Of the 13 states with a published fee-for-service rate, the median is $1,400.00. Colorado pays the most ($1,754.83) and Connecticut the least ($383.06).
Which state pays the highest Medicaid rate for A4264?
Colorado, at $1,754.83, effective 2023-01-01.
Do managed-care plans pay the same rate for A4264?
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.