A9615 Medicaid reimbursement rate by state (2026)
Injection, pegulicianine, 1 mg. Medicaid pays a median of $35.38 for A9615 across 6 states, from $31.84 in Arizona to $37.51 in Mississippi.
- States publishing
- 6
- National median
- $35.38units vary by state
- Lowest
- $31.84Arizona
- Highest
- $37.51Mississippi
What does Medicaid pay for A9615?
6 state Medicaid programs publish a fee-for-service rate for A9615. The national median is $35.38 (units differ between states). Mississippi pays the most, $37.51, and Arizona the least, $31.84, a 1.2x spread.
A9615 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 6 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 A9615, 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. 1 of the 6 states list more than one rate for A9615, 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. None of the 6 schedules prints a separate unit for A9615, so each amount is a flat payment for one service as the code defines it.
- Per hour. A9615 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 A9615, 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 A9615 rates differ between states
Published rates for A9615 run from $31.84 in Arizona to $37.51 in Mississippi, a 1.2x gap in the same unit. Half the states pay more than the median of $35.38 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. 1 state set the current rate for A9615 in 2026 or later. 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 A9615
What a plan pays for A9615 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 6 states.
In 3 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 2 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet.
- Plans must pay at least the published rate (3 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.
- Plans negotiate; the published rate applies out of network (2 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.
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 Mississippi managed care.
Units and billing for A9615
A9615 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 A9615?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $35.38. Mississippi pays the most ($37.51) and Arizona the least ($31.84).
Which state pays the highest Medicaid rate for A9615?
Mississippi, at $37.51, effective 2025-01-01.
Which state pays the lowest Medicaid rate for A9615?
Arizona, at $31.84, effective 2026-08-01.
What unit is A9615 billed in?
None of the 6 schedules prints a separate unit for A9615, so each amount is a flat payment for one service as the code defines it.
Do managed-care plans pay the same rate for A9615?
Not necessarily. In 3 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 2 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.