A4412 Medicaid reimbursement rate by state (2026)
Ostomy pouch, drainable, high output. Medicaid pays a median of $3.11 for A4412 across 45 states, from $2.13 in Ohio to $15.95 in New Hampshire.
- States publishing
- 45
- National median
- $3.11units vary by state
- Lowest
- $2.13Ohio
- Highest
- $15.95New Hampshire
What does Medicaid pay for A4412?
45 state Medicaid programs publish a fee-for-service rate for A4412. The national median is $3.11 (units differ between states). New Hampshire pays the most, $15.95, and Ohio the least, $2.13 per Each, a 7.5x spread.
A4412 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 45 states with every variant, modifier and effective date.
How to read this table
- Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for A4412, 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. 15 of the 45 states list more than one rate for A4412, 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 45 states, 4 publish A4412 per unit, and 41 schedules print no unit at all (a flat amount per service).
- Per hour. A4412 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 A4412, 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.
Why A4412 rates differ between states
Published rates for A4412 run from $2.13 in Ohio to $15.95 in New Hampshire. The two publish it in different units (no unit printed versus Each), so part of that gap is the unit rather than the price. Half the states pay more than the median of $3.11 and half pay less. The usual reasons for a spread like this in equipment & supplies rates:
- 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.
- A single code can carry separate purchase, rental and used-equipment amounts, and states publish different subsets of them.
Timing matters too. 22 states set the current rate for A4412 in 2026 or later, while 13 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.
What managed-care plans pay for A4412
No managed-care plan publishes what it pays for A4412. 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 9 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 21 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 15 states is not classified yet.
- Plans negotiate; the published rate applies out of network (21 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 (9 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.
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 New Hampshire managed care.
Units and billing for A4412
A4412 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.
Pricing modifiers decide which amount applies: NU for a new purchase, RR for a monthly rental and UE for used equipment. 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.
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.
Frequently asked questions
What does Medicaid pay for A4412?
It depends on the state. Of the 45 states with a published fee-for-service rate, the median is $3.11. New Hampshire pays the most ($15.95) and Ohio the least ($2.13 per Each).
Which state pays the highest Medicaid rate for A4412?
New Hampshire, at $15.95, effective 2021-01-01.
Which state pays the lowest Medicaid rate for A4412?
Ohio, at $2.13 per Each, effective 2021-07-01. It publishes the code in a different unit from New Hampshire, so compare per unit with care.
What unit is A4412 billed in?
Of the 45 states, 4 publish A4412 per unit, and 41 schedules print no unit at all (a flat amount per service).
Do managed-care plans pay the same rate for A4412?
Not necessarily. In 9 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 21 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 15 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.