A7501 Medicaid reimbursement rate by state (2026)
Tracheostoma valve, including diaphragm, each. Medicaid pays a median of $120.77 for A7501 across 40 states, from $0.91 in Louisiana to $185.15 in North Dakota.
- States publishing
- 40
- National median
- $120.77units vary by state
- Lowest
- $0.91Louisiana
- Highest
- $185.15North Dakota
What does Medicaid pay for A7501?
40 state Medicaid programs publish a fee-for-service rate for A7501. The national median is $120.77 (units differ between states). North Dakota pays the most, $185.15, and Louisiana the least, $0.91, a 203.5x spread.
A7501 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 40 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 A7501, 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. 12 of the 40 states list more than one rate for A7501, 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 40 states, 3 publish A7501 per unit, and 37 schedules print no unit at all (a flat amount per service).
- Per hour. A7501 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 A7501, 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 A7501 rates differ between states
Published rates for A7501 run from $0.91 in Louisiana to $185.15 in North Dakota, a 203.5x gap in the same unit. Half the states pay more than the median of $120.77 and half pay less. The usual reasons for a spread like this in equipment & supplies rates:
- 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.
- Some items are priced individually from the manufacturer's price or the supplier's invoice, so fewer states publish a fixed fee.
Timing matters too. 22 states set the current rate for A7501 in 2026 or later, while 10 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 A7501
No managed-care plan publishes what it pays for A7501. 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 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 13 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 North Dakota managed care.
Units and billing for A7501
A7501 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 A7501?
It depends on the state. Of the 40 states with a published fee-for-service rate, the median is $120.77. North Dakota pays the most ($185.15) and Louisiana the least ($0.91).
Which state pays the highest Medicaid rate for A7501?
North Dakota, at $185.15, effective 2026-07-01.
Which state pays the lowest Medicaid rate for A7501?
Louisiana, at $0.91, effective 2012-07-01.
What unit is A7501 billed in?
Of the 40 states, 3 publish A7501 per unit, and 37 schedules print no unit at all (a flat amount per service).
Do managed-care plans pay the same rate for A7501?
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 13 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.