L8600 Medicaid reimbursement rate by state (2026)
Implantable breast prosthesis, silicone or equal. Medicaid pays a median of $646.40 for L8600 across 21 states, from $9.08 in Rhode Island to $1,019.30 in Minnesota.
- States publishing
- 21
- National median
- $646.40units vary by state
- Lowest
- $9.08Rhode Island
- Highest
- $1,019.30Minnesota
What does Medicaid pay for L8600?
21 state Medicaid programs publish a fee-for-service rate for L8600. The national median is $646.40 (units differ between states). Minnesota pays the most, $1,019.30, and Rhode Island the least, $9.08, a 112.3x spread.
L8600 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 21 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 L8600, 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. 4 of the 21 states list more than one rate for L8600, 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 21 schedules prints a separate unit for L8600, so each amount is a flat payment for one service as the code defines it.
- Per hour. L8600 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 L8600, 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 L8600 rates differ between states
Published rates for L8600 run from $9.08 in Rhode Island to $1,019.30 in Minnesota, a 112.3x gap in the same unit. Half the states pay more than the median of $646.40 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. 14 states set the current rate for L8600 in 2026 or later, while 3 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.
What managed-care plans pay for L8600
What a plan pays for L8600 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 21 states.
In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 11 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 8 states is not classified yet.
- Plans negotiate; the published rate applies out of network (11 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.
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 Minnesota managed care.
Units and billing for L8600
L8600 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.
Frequently asked questions
What does Medicaid pay for L8600?
It depends on the state. Of the 21 states with a published fee-for-service rate, the median is $646.40. Minnesota pays the most ($1,019.30) and Rhode Island the least ($9.08).
Which state pays the highest Medicaid rate for L8600?
Minnesota, at $1,019.30, effective 2026-01-01.
Which state pays the lowest Medicaid rate for L8600?
Rhode Island, at $9.08, effective 2014-04-01.
What unit is L8600 billed in?
None of the 21 schedules prints a separate unit for L8600, so each amount is a flat payment for one service as the code defines it.
Do managed-care plans pay the same rate for L8600?
Not necessarily. In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 11 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 8 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.