A4490 Medicaid reimbursement rates by state
Surgical stockings above knee length, each. 28 state Medicaid programs publish a fee-for-service rate for A4490 at the physician psychologist level. Rates run from $0.01 in Missouri to $85.61 in Vermont, with a median of $15.38.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 28
- Median rate
- $15.38units vary by state
- Highest
- $85.61Vermont
- Medicare (non-facility)
- —not on the physician fee schedule
A4490 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 |
|---|---|---|---|---|---|---|
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $85.61⚠ over 3× mediansince 2023-03-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $85.04⚠ over 3× mediansince 2021-01-01 | — | — | Not classified | — | 2026 Fee Schedule - Covered Procedures R |
| DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $60.00⚠ over 3× mediansince 2024-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2024 Physician Fee Schedule |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $58.14since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $45.91since 2012-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $29.70since 2026-04-01 | — | — | Plans must pay at least this | — | BMS DME 2026 Rural Fee Schedule Effectiv |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $25.00since 2006-10-15 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid (KMAP fee-for-service schedule) | $25.00since 2009-05-01 | — | — | Plans must pay at least this | — | KMAP Fee Schedule TXIX Medicaid (FeeSche |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $20.32since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid DME fee schedule ( |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $19.67since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $18.53since 2021-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $17.80since 2011-07-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Dmepo |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $17.25since 2010-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health) | $15.50since 2025-10-01 | — | — | Not classified | — | Alaska Medicaid DMEPOS Interim Fee Sched |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $15.25since 2010-07-01 | Each | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $14.78since 2025-10-01 | each | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Home Health Se |
| ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $11.98since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $11.44since 2024-03-04 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $10.00since 2012-07-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $9.95since 2026-05-20 | — | — | Not classified | — | EPSDT Referral (DME) Fee Schedule (REF-0 |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $7.94since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $7.50since 2024-07-01 | — | — | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $7.26since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $7.21since 2026-01-01 | — | — | Not classified | — | MaineCare Section 60, Medical Supplies a |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $6.77since 2022-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $6.23since 2024-01-01 | — | — | Plans must pay at least this | — | Provider Type 20 Physician, MD., Osteopa |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $5.40since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $0.01since 2003-10-16 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Home Health |
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 A4490?
It depends on the state. Of the 28 states with a published fee-for-service rate, the median is $15.38. Vermont pays the most ($85.61) and Missouri the least ($0.01).
Which state pays the highest Medicaid rate for A4490?
Vermont, at $85.61, effective 2023-03-01.
Do managed-care plans pay the same rate for A4490?
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.
Related Equipment & supplies codes
L0120Cervical, flexible, non-adjustable, prefabricated · 48 statesL0130Cervical, flexible, thermoplastic collar, molded to patient · 48 statesL0140Cervical, semi-rigid, adjustable (plastic collar) · 48 statesL0150Cervical, semi-rigid, adjustable molded chin cup · 48 statesL0172Cervical, collar, semi-rigid thermoplastic foam, two-piece · 48 statesL0174Cervical, collar, semi-rigid, thermoplastic foam · 48 statesL0200Cervical, multiple post collar · 48 statesL0220Thoracic, rib belt, custom fabricated · 48 statesL0450Tlso, flexible, provides trunk support · 48 statesL0472Tlso, triplanar control, hyperextension · 48 statesL0482Tlso, triplanar control · 48 statesL0484Tlso, triplanar control · 48 states
Track A4490 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.