A4397 Medicaid reimbursement rates by state
Irrigation supply; sleeve, each. 9 state Medicaid programs publish a fee-for-service rate for A4397. Rates run from $2.76 in New York to $6.56 in Arizona, with a median of $4.41.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 9
- Median rate
- $4.41units vary by state
- Highest
- $6.56Arizona
- Medicare (non-facility)
- —not on the physician fee schedule
A4397 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 |
|---|---|---|---|---|---|---|
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $6.56since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $4.55since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2024-01- |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $4.46since 2021-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $4.45since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Home Health fee schedule (20 |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $4.41since 2001-04-01 | Each | — | Plans negotiate; applies out of network | — | Appendix to OAC 5160-10-01, final filed |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $3.99since 2025-10-01 | each | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Home Health Se |
| FloridaAny qualified provider (rate does not vary by provider) · Florida iBudget waiver for people with developmental disabilities (APD) | $3.94since 2015-10-19 | — | — | Paid by the state, outside plans | — | Developmental Disabilities Individual Bu |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $3.53since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | DME Fee Schedule - Excel.xlsx |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $2.76since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
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 A4397?
It depends on the state. Of the 9 states with a published fee-for-service rate, the median is $4.41. Arizona pays the most ($6.56) and New York the least ($2.76).
Which state pays the highest Medicaid rate for A4397?
Arizona, at $6.56, effective 2021-10-01.
Do managed-care plans pay the same rate for A4397?
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.