A4627 Medicaid reimbursement rates by state
Spacer, bag or reservoir, with or without mask. 35 state Medicaid programs publish a fee-for-service rate for A4627 at the physician psychologist level. Rates run from $11.70 in Wyoming to $50.09 in Nebraska, with a median of $29.51.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 35
- Median rate
- $29.51units vary by state
- Highest
- $50.09Nebraska
- Medicare (non-facility)
- —not on the physician fee schedule
A4627 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 |
|---|---|---|---|---|---|---|
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $50.09since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $46.35since 2026-01-01 | — | — | Not classified | — | MaineCare Section 90, Physician Services |
| North DakotaAny qualified provider (rate does not vary by provider) · North Dakota Medicaid (fee-for-service) | $45.00since 2026-07-01 | — | — | Not classified | — | ND Medicaid DME and Supplies Fee Schedul |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $40.39since 2021-01-01 | — | — | Not classified | — | 2026 Fee Schedule - Covered Procedures R |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $38.00since 2020-01-01 | — | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2020Medica |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $37.37since 2022-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $36.43since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Durable Medica |
| UtahPhysician or licensed psychologist (incl. BCBA-D) · Utah Medicaid (fee-for-service, Traditional plan) | $35.34since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $34.72since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $32.00since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $31.33since 2011-04-08 | — | — | Not classified | — | SCDHHS Pediatric Subspecialty and Neonat |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $31.05since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| TexasAny qualified provider (rate does not vary by provider) · Healthy Texas Women (women's health and family planning, 1115 waiver) | $30.82since 2017-04-01 | — | — | Not classified | — | TMHP Texas Medicaid Fee Schedule - Healt |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $30.82since 2012-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $30.61since 2013-07-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $29.98since 2021-01-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, June 202 |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $29.79since 2024-07-01 | — | — | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $29.51since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Durable Medical Equipment and Medical Su |
| AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health) | $29.49since 2025-10-01 | — | — | Not classified | — | Alaska Medicaid DMEPOS Interim Fee Sched |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $27.18since 2025-06-04 | — | — | Not classified | — | Arkansas Medicaid Prosthetics (includes |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $24.95since 2010-07-01 | Each | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $24.00since 2012-07-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $23.70since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | HCA Physician-related services fee sched |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $23.22since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $22.00since 2006-03-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $21.14since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid DME fee schedule ( |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $20.80since 2024-03-04 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $20.61since 2026-04-01 | — | — | Plans must pay at least this | — | BMS DME 2026 Rural Fee Schedule Effectiv |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $18.00since 2005-12-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $15.79since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $15.77since 2024-01-01 | — | — | Plans must pay at least this | — | Provider Type 20 Physician, MD., Osteopa |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $15.75since 2008-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Supplies |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $14.68since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $13.28since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $11.70since 2021-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
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 A4627?
It depends on the state. Of the 35 states with a published fee-for-service rate, the median is $29.51. Nebraska pays the most ($50.09) and Wyoming the least ($11.70).
Which state pays the highest Medicaid rate for A4627?
Nebraska, at $50.09, effective 2026-07-01.
Do managed-care plans pay the same rate for A4627?
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
L0120Cervical, flexible, non-adjustable, prefabricated · 50 statesL0130Cervical, flexible, thermoplastic collar, molded to patient · 50 statesL0140Cervical, semi-rigid, adjustable (plastic collar) · 50 statesL0172Cervical, collar, semi-rigid thermoplastic foam, two-piece · 50 statesL0450Tlso, flexible, provides trunk support · 50 statesL0472Tlso, triplanar control, hyperextension · 50 statesL0482Tlso, triplanar control · 50 statesL0484Tlso, triplanar control · 50 statesL0486Tlso, triplanar control · 50 statesL0627Lumbar orthosis, sagittal control · 50 statesL0700Cervical-thoracic-lumbar-sacral-orthoses (ctlso) · 50 statesL0984Protective body sock, prefabricated, off-the-shelf, each · 50 states
Track A4627 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.