A4355 Medicaid reimbursement rates by state
Irrigation tubing set for continuous bladder irrigation.... 20 state Medicaid programs publish a fee-for-service rate for A4355 at the agency level. Rates run from $2.70 in Ohio to $12.71 in Minnesota, with a median of $8.91.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 20
- Median rate
- $8.91units vary by state
- Highest
- $12.71Minnesota
- Medicare (non-facility)
- —not on the physician fee schedule
A4355 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 |
|---|---|---|---|---|---|---|
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $12.71since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $12.05since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $11.44since 2026-01-01 | Each | — | Plans must pay at least this | — | DMAS procedure fee file hcpcmedical.csv |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $11.00since 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) | $10.80since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $9.75since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Home Health fee schedule (20 |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $9.55since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | HCA Medical equipment and supplies fee s |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $9.19since 2008-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Supplies |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $9.08since 2022-10-17 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Durable Medic |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $8.91since 1996-01-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $8.90since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $8.79since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $8.32since 2019-07-24 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2019-07- |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $7.94since 1997-07-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Dmepo |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $7.05since 2014-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $6.92since 2024-08-15 | — | — | Not classified | — | SCDHHS Durable Medical Equipment (DME) F |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $5.89since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $5.73since 2021-09-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| FloridaAny qualified provider (rate does not vary by provider) · Florida iBudget waiver for people with developmental disabilities (APD) | $2.83since 2026-07-01 | Item | — | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $2.70since 1990-05-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
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 A4355?
It depends on the state. Of the 20 states with a published fee-for-service rate, the median is $8.91. Minnesota pays the most ($12.71) and Ohio the least ($2.70 per Each).
Which state pays the highest Medicaid rate for A4355?
Minnesota, at $12.71, effective 2026-01-01.
Do managed-care plans pay the same rate for A4355?
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 A4355 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.