T4539 Medicaid reimbursement rates by state
Incontinence product, diaper/brief, reusable, any size, each. 14 state Medicaid programs publish a fee-for-service rate for T4539. Rates run from $1.36 in New Hampshire to $31.73 in Massachusetts, with a median of $6.81.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 14
- Median rate
- $6.81units vary by state
- Highest
- $31.73Massachusetts
- Medicare (non-facility)
- —not on the physician fee schedule
T4539 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 |
|---|---|---|---|---|---|---|
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $31.73⚠ over 3× mediansince 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $21.26⚠ over 3× mediansince 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina CAP consumer-directed option (CAP/CD) | $20.80since 2025-10-01 | Each | — | Paid by the state, outside plans | — | NC Medicaid fee schedule 'CAP- Consumer |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $11.00since 2005-03-28 | Pack of 10 | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $10.73since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $7.35since 2023-08-15 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $6.90since 2014-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $6.72since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $5.92since 2013-07-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $4.87since 2026-01-01 | — | — | Not classified | — | MaineCare Section 60, Medical Supplies a |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $2.49since 2012-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $2.40since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | HCA Medical equipment and supplies fee s |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $1.80since 2005-03-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Med |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $1.36since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 T4539?
It depends on the state. Of the 14 states with a published fee-for-service rate, the median is $6.81. Massachusetts pays the most ($31.73) and New Hampshire the least ($1.36).
Which state pays the highest Medicaid rate for T4539?
Massachusetts, at $31.73, effective 2026-03-01.
Do managed-care plans pay the same rate for T4539?
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.