E0642 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 E0642, 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. 5 of the 8 states list more than one rate for E0642, 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 8 schedules prints a separate unit for E0642, so each amount is a flat payment for one service as the code defines it.
• Per hour. E0642 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 E0642, 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 E0642 run from $5.82 in Wisconsin to $3,170.53 in Texas, a 544.8x gap in the same unit. Half the states pay more than the median of $650.12 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. 1 state set the current rate for E0642 in 2026 or later, while 4 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 E0642, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 3 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 3 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 2 states is not classified yet.

• Plans negotiate; the published rate applies out of network (3 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 (2 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 Texas managed care.

E0642 is a HCPCS Level II durable medical equipment code in the equipment & supplies line, billed mostly by durable medical equipment suppliers, orthotists, prosthetists and pharmacies. E codes cover durable medical equipment. The same code can carry a purchase price, a monthly rental and a used-equipment price, chosen with a pricing modifier.

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.