A4284 Medicaid reimbursement rates by state
Breast shield and splash protector for use with breast pump. 17 state Medicaid programs publish a fee-for-service rate for A4284. Rates run from $1.83 in Michigan to $18.45 in Massachusetts, with a median of $8.85.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 17
- Median rate
- $8.85units vary by state
- Highest
- $18.45Massachusetts
- Medicare (non-facility)
- —not on the physician fee schedule
A4284 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 |
|---|---|---|---|---|---|---|
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $18.45since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $16.89since 2008-01-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $16.56since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $14.88since 2021-01-01 | — | — | Not classified | — | 2026 Fee Schedule - Covered Procedures R |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $14.54since 2022-10-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Med |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $13.30since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Durable Medic |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $9.67since 2022-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $9.09since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | Provider Type 33, Durable Medical Equipm |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $8.85since 2022-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $8.82since 2026-01-01 | — | — | Not classified | — | MaineCare Section 60, Medical Supplies a |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $8.00since 2025-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Dmepo |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $8.00since 2019-01-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $7.03since 2023-03-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $3.94since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Durable Medica |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $3.29since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2025-01- |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $3.17since 2024-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #12 MEDICAL S |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $1.83since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
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 A4284?
It depends on the state. Of the 17 states with a published fee-for-service rate, the median is $8.85. Massachusetts pays the most ($18.45) and Michigan the least ($1.83).
Which state pays the highest Medicaid rate for A4284?
Massachusetts, at $18.45, effective 2026-03-01.
Do managed-care plans pay the same rate for A4284?
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.
Related Equipment & supplies codes
A7000Canister, disposable, used with suction pump, each · 42 statesA8001Helmet, protective, hard, prefabricated · 42 statesB9002Enteral nutrition infusion pump, any type · 42 statesE0105Cane, quad or three prong, includes canes of all materials · 42 statesE0130Walker, rigid (pickup), adjustable or fixed height · 42 statesE0135Walker, folding (pickup), adjustable or fixed height · 42 statesE0143Walker, folding, wheeled, adjustable or fixed height · 42 statesE0149Walker, heavy duty, wheeled, rigid or folding, any type · 42 statesE0163Commode chair, mobile or stationary, with fixed arms · 42 statesE0185Gel or gel-like pressure pad for mattress · 42 statesE0271Mattress, innerspring · 42 statesE0470Respiratory assist device, bi-level pressure capability · 42 states
Track A4284 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.