B4162 Medicaid reimbursement rates by state
Enteral formula, for pediatrics. 16 state Medicaid programs publish a fee-for-service rate for B4162. Rates run from $1.12 in Hawaii to $32.08 in Louisiana, with a median of $3.61.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 16
- Median rate
- $3.61units vary by state
- Highest
- $32.08Louisiana
- Medicare (non-facility)
- —not on the physician fee schedule
B4162 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 |
|---|---|---|---|---|---|---|
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $32.08since 2021-05-01 | 1 UNIT = 1 CAN | — | Plans must pay at least this | — | Louisiana Medicaid DME Metabolic Formula |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $8.82since 2012-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Dmepo |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $7.02since 2026-01-01 | — | — | Not classified | — | MaineCare Section 60, Medical Supplies a |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $6.98since 2025-08-12 | — | — | Not classified | — | Arkansas Medicaid Hyperalimentation Fee |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $5.36since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $4.72since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $4.00since 2019-01-01 | — | — | Plans negotiate; applies out of network | — | Durable Medical Equipment Fee Schedule 1 |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina CAP consumer-directed option (CAP/CD) | $3.86since 2025-10-01 | 100 CAL | — | Paid by the state, outside plans | — | NC Medicaid fee schedule 'CAP- Consumer |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $3.36since 2019-04-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $3.35since 2021-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Enteral nutrition fee schedule (ente |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $3.31since 2021-02-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $3.21since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid Enteral Therapy Ch |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $2.11since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $1.43since 2013-01-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $1.30since 2005-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Supplies |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $1.12since 2024-03-04 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
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 B4162?
It depends on the state. Of the 16 states with a published fee-for-service rate, the median is $3.61. Louisiana pays the most ($32.08 per 1 UNIT = 1 CAN) and Hawaii the least ($1.12).
Which state pays the highest Medicaid rate for B4162?
Louisiana, at $32.08 per 1 UNIT = 1 CAN, effective 2021-05-01.
Do managed-care plans pay the same rate for B4162?
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.