A4459 Medicaid reimbursement rates by state
Manual transanal irrigation system. 16 state Medicaid programs publish a fee-for-service rate for A4459 at the clinical nurse specialist level. Rates run from $40.11 in Kansas to $465.50 in Idaho, with a median of $166.37.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 16
- Median rate
- $166.37units vary by state
- Highest
- $465.50Idaho
- Medicare (non-facility)
- —not on the physician fee schedule
A4459 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 |
|---|---|---|---|---|---|---|
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $465.50since 2023-10-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $270.00since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | Copy of Durable Medical Equipment Servic |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $232.00since 2026-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $204.75since 2023-09-05 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $200.10since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2025-01- |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $180.00since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $180.00since 2022-05-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth interactive max fee schedu |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $172.31since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $160.42since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $157.27since 2025-10-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $157.27since 2025-10-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Med |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $136.36since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $131.01since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $128.34since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $112.29since 2026-06-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $40.11since 2026-07-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
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 A4459?
It depends on the state. Of the 16 states with a published fee-for-service rate, the median is $166.37. Idaho pays the most ($465.50) and Kansas the least ($40.11).
Which state pays the highest Medicaid rate for A4459?
Idaho, at $465.50, effective 2023-10-01.
Do managed-care plans pay the same rate for A4459?
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 A4459 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.