T4542 Medicaid reimbursement rates by state
Incontinence product, disposable underpad, small size, each. 23 state Medicaid programs publish a fee-for-service rate for T4542. Rates run from $0.16 in Maine to $30.00 in Virginia, with a median of $0.29.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 23
- Median rate
- $0.29units vary by state
- Highest
- $30.00Virginia
- Medicare (non-facility)
- —not on the physician fee schedule
T4542 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 |
|---|---|---|---|---|---|---|
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $30.00⚠ over 3× mediansince 2014-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $0.62since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $0.50since 2013-07-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $0.47since 2014-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $0.45since 2023-09-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $0.43since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Home Health fee schedule (20 |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $0.41since 2011-08-01 | — | — | Plans negotiate; applies out of network | — | Provider Type 33, Durable Medical Equipm |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $0.40since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma ADvantage 1915(c) waiver (older adults and adults with physical disabilities) | $0.38since 2024-10-01 | unit | — | Paid by the state, outside plans | — | Reimbursement Rates for Services, ADvant |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $0.38since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health) | $0.35since 2025-10-01 | — | — | Not classified | — | Alaska Medicaid DMEPOS Interim Fee Sched |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $0.29since 2011-03-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Med |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $0.29since 2015-06-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $0.28since 2005-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $0.27since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $0.24since 2012-07-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $0.23since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $0.20since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2024 Physician Fee Schedule |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $0.19since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $0.19since 2013-01-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $0.19since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $0.19since 2023-08-15 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $0.16since 2023-01-01 | — | — | Not classified | — | MaineCare Section 60, Medical Supplies a |
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 T4542?
It depends on the state. Of the 23 states with a published fee-for-service rate, the median is $0.29. Virginia pays the most ($30.00) and Maine the least ($0.16).
Which state pays the highest Medicaid rate for T4542?
Virginia, at $30.00, effective 2014-01-01.
Do managed-care plans pay the same rate for T4542?
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.
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Track T4542 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.