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A4604 Medicaid reimbursement rates by state

Tubing with integrated heating element for use with positive.... 37 state Medicaid programs publish a fee-for-service rate for A4604 at the nurse midwife level. Rates run from $5.18 in Iowa to $85.74 in Nebraska, with a median of $50.59.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
37
Median rate
$50.59units vary by state
Highest
$85.74Nebraska
Medicare (non-facility)
—not on the physician fee schedule

A4604 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.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$85.74since 2026-07-01——Plans negotiate; applies out of network—Nebraska Medicaid fee schedule 471-000-5
New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS)$71.02since 2021-01-01——Not classified—2026 Fee Schedule - Covered Procedures R
AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health)$68.58since 2026-01-01——Not classified—Alaska Medicaid DMEPOS Interim Fee Sched
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$66.71since 2024-01-01——Plans must pay at least this—DME Fee Schedule for Items Supplied to R
WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health)$61.88since 2026-07-01——Not classified—Wyoming Medicaid Downloadable Fee Schedu
South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services)$61.88since 2026-01-01——Not classified—South Dakota Medicaid DME fee schedule (
WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service$61.66since 2021-07-01——Plans negotiate; applies out of network—HCA Respiratory care fee schedule (respi
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$59.40since 2026-07-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$57.50since 2025-01-01——Plans negotiate; applies out of network—HFS DME Fee Schedule (effective 2025-01-
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$57.47since 2026-01-01——Not classified—Vermont Medicaid Fee Schedule - DME Code
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$55.57since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$53.45since 2016-07-01——Plans negotiate; applies out of network—DME Fee Schedule - Excel.xlsx
PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service)$53.45since 2007-01-02——Plans negotiate; applies out of network—PA DHS PROMISe Outpatient Fee Schedule (
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$53.40since 2016-02-08Each—Plans negotiate; applies out of network—ODM DMEPOS combined payment schedules (a
ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$53.19since 2026-10-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Durable
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$52.55since 2026-01-01——Not classified—MaineCare Section 60, Medical Supplies a
NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules)$51.97since 2017-01-01——Plans negotiate; applies out of network—Provider Type 33, Durable Medical Equipm
OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA)$51.22since 2024-10-01——Plans negotiate; applies out of network—OHP FFS medical-dental fee schedule (fee
MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service)$50.59since 2026-01-01——Not classified—Montana Healthcare Programs fee schedule
DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP)$49.98since 2026-01-01——Plans negotiate; applies out of network—DMAP 2026 Physician Fee Schedule
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$49.52since 2026-01-01——Plans must pay at least this—SoonerCare Durable Medical Equipment Rat
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$49.31since 2026-01-01——Plans negotiate; applies out of network—MHCP Fee Schedule - Current Fee Schedule
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$48.91since 2026-01-01Each—Plans must pay at least this—DMAS procedure fee file hcpcmedical.csv
ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service)$48.35since 2026-07-01New Purchase—Not classified—Durable Medical Equipment Fee Schedule (
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$46.92since 2024-07-01——Not classified—SCDHHS Durable Medical Equipment (DME) F
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$46.37since 2025-10-01——Plans negotiate; applies out of network—NC Medicaid fee schedule 'Durable Medica
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$45.79since 2026-01-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service)$44.86since 2006-01-01——Plans negotiate; applies out of network—RI Medicaid Interactive Fee For Service
MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH)$42.48since 2026-01-01——Not classified—Maryland Medicaid DME/DMS/Oxygen, Prosth
MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations)$42.23since 2026-03-01——Plans negotiate; applies out of network—Rates for Durable Medical Equipment, Oxy
West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services)$41.10since 2026-04-01——Plans must pay at least this—BMS DME 2026 Competitive Bidding Schedul
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$39.97since 2018-08-01——Not classified—CMAP fee schedule: 10/01/2026 MEDS - Med
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$39.45since 2026-07-01——Paid by the state, outside plans—KMAP Fee Schedule MKN Medicaid (FeeSched
KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules)$38.55since 2020-01-01——State sets the plan rate—KY Medicaid DME fee schedule (2020Medica
MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service)$38.50since 2020-04-01——Plans negotiate; applies out of network—MO HealthNet fee schedule: Durable Medic
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$34.99since 2026-07-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$5.18since 2024-07-01——State sets the plan rate—Iowa Medicaid fee schedule #08 PHARMACY

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 A4604?

It depends on the state. Of the 37 states with a published fee-for-service rate, the median is $50.59. Nebraska pays the most ($85.74) and Iowa the least ($5.18).

Which state pays the highest Medicaid rate for A4604?

Nebraska, at $85.74, effective 2026-07-01.

Do managed-care plans pay the same rate for A4604?

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.

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