L4205 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 45 of the 46 states publish L4205 per 15 min, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 15 of the 46 states list more than one rate for L4205, 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 46 states, 45 publish L4205 per 15 min and 1 per unit.
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 45 of the 46 states bill L4205 by time, with a median of $85.64 per hour.
• 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 L4205, 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 L4205 run from $7.00 in Louisiana to $51.78 in Alaska, a 7.4x gap in the same unit. Half the states pay more than the median of $21.33 and half pay less. The usual reasons for a spread like this in equipment & supplies rates:

• 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.
• Many states set equipment and supply fees as a percentage of the Medicare DMEPOS fee schedule, at different percentages and from different years.

Timing matters too. 26 states set the current rate for L4205 in 2026 or later, while 13 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.

No managed-care plan publishes what it pays for L4205. 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 9 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 17 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 (7 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 Alaska managed care.

L4205 is a HCPCS Level II orthotic and prosthetic code in the equipment & supplies line, billed mostly by durable medical equipment suppliers, orthotists, prosthetists and pharmacies. L codes cover orthotic and prosthetic devices. Each is paid per device, and some are priced individually from the supplier's invoice.

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.