A5507 Medicaid reimbursement rate by state (2026)
For diabetics only, not otherwise specified modification. Medicaid pays a median of $34.98 for A5507 across 44 states, from $11.45 in Kansas to $54.95 in Alaska.
- States publishing
- 44
- National median
- $34.98units vary by state
- Lowest
- $11.45Kansas
- Highest
- $54.95Alaska
What does Medicaid pay for A5507?
44 state Medicaid programs publish a fee-for-service rate for A5507. The national median is $34.98 (units differ between states). Alaska pays the most, $54.95, and Kansas the least, $11.45, a 4.8x spread.
A5507 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 44 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 A5507, 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 44 states list more than one rate for A5507, 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 44 states, 2 publish A5507 per unit, and 42 schedules print no unit at all (a flat amount per service).
- Per hour. A5507 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 A5507, 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 A5507 rates differ between states
Published rates for A5507 run from $11.45 in Kansas to $54.95 in Alaska, a 4.8x gap in the same unit. Half the states pay more than the median of $34.98 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. 24 states set the current rate for A5507 in 2026 or later, while 14 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 A5507
Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For A5507, the public signal is the rule each state sets for its plans, recorded on each rate above.
In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 20 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 17 states is not classified yet.
- Plans negotiate; the published rate applies out of network (20 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 (6 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.
- The state sets the plan rate (1 state). There is little to negotiate on price. Contracting is about network participation, authorization and billing terms.
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 Alaska managed care.
Units and billing for A5507
A5507 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.
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. Pricing modifiers decide which amount applies: NU for a new purchase, RR for a monthly rental and UE for used equipment.
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 A5507?
It depends on the state. Of the 44 states with a published fee-for-service rate, the median is $34.98. Alaska pays the most ($54.95) and Kansas the least ($11.45).
Which state pays the highest Medicaid rate for A5507?
Alaska, at $54.95, effective 2026-01-01.
Which state pays the lowest Medicaid rate for A5507?
Kansas, at $11.45, effective 2026-07-01.
What unit is A5507 billed in?
Of the 44 states, 2 publish A5507 per unit, and 42 schedules print no unit at all (a flat amount per service).
Do managed-care plans pay the same rate for A5507?
Not necessarily. In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 20 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 17 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.