B4197 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for B4197, 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. 10 of the 34 states list more than one rate for B4197, 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 34 states, 1 publish B4197 per unit and 1 per one/day, and 32 schedules print no unit at all (a flat amount per service).
• Per hour. B4197 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 B4197, 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.

Published rates for B4197 run from $65.87 in Colorado to $511.68 in Arizona, a 7.8x gap in the same unit. Half the states pay more than the median of $307.96 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. 16 states set the current rate for B4197 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.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For B4197, 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 15 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 12 states is not classified yet.

• Plans negotiate; the published rate applies out of network (15 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 (5 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 (2 states). 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 Arizona managed care.

B4197 is a HCPCS Level II enteral and parenteral therapy code in the equipment & supplies line, billed mostly by durable medical equipment suppliers, orthotists, prosthetists and pharmacies. B codes cover enteral and parenteral nutrition, supplies and pumps. They are commonly billed per unit of nutrient or per day of supplies, and pumps may be rented or purchased.

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.