A4263 Medicaid reimbursement rates by state
Permanent, long term, non-dissolvable lacrimal duct implant. 9 state Medicaid programs publish a fee-for-service rate for A4263 at the physician psychologist level. Rates run from $9.50 in North Carolina to $78.31 in New Mexico, with a median of $33.56.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 9
- Median rate
- $33.56units vary by state
- Highest
- $78.31New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
A4263 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 |
|---|---|---|---|---|---|---|
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $78.31since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $69.64since 2013-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $48.87since 2022-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $37.80since 2004-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Vision ( |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $33.56since 2024-01-01 | — | — | Plans must pay at least this | — | Provider Type 20 Physician, MD., Osteopa |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $25.02since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $24.98since 2011-04-08 | — | — | Not classified | — | SCDHHS Pediatric Subspecialty and Neonat |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $20.00since 1989-01-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $9.50since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Physician Serv |
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 A4263?
It depends on the state. Of the 9 states with a published fee-for-service rate, the median is $33.56. New Mexico pays the most ($78.31) and North Carolina the least ($9.50).
Which state pays the highest Medicaid rate for A4263?
New Mexico, at $78.31, effective 2025-01-01.
Do managed-care plans pay the same rate for A4263?
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.