B4103 Medicaid reimbursement rates by state
Enteral formula, for pediatrics. 16 state Medicaid programs publish a fee-for-service rate for B4103. Rates run from $0.60 in Ohio to $5.93 in Indiana, with a median of $3.31.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 16
- Median rate
- $3.31units vary by state
- Highest
- $5.93Indiana
- Medicare (non-facility)
- —not on the physician fee schedule
B4103 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 |
|---|---|---|---|---|---|---|
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $5.93since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $5.86since 2025-08-12 | — | — | Not classified | — | Arkansas Medicaid Hyperalimentation Fee |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $5.36since 2010-07-01 | 500 ml = 1 unit | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $5.33since 2020-08-01 | — | — | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $5.00since 2024-07-01 | — | — | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $4.84since 2023-05-10 | — | — | Not classified | — | SCDHHS Durable Medical Equipment (DME) F |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $3.33since 2023-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Dmepo |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $3.33since 2021-02-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $3.29since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Durable Medica |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $2.92since 2005-12-12 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $2.53since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Durable Medic |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $1.75since 2021-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Enteral nutrition fee schedule (ente |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $1.47since 2024-04-01 | — | — | 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) | $1.06since 2023-01-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid DME Enteral Nutrition |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $0.93since 2012-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Supplies |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $0.60since 2014-06-01 | 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 B4103?
It depends on the state. Of the 16 states with a published fee-for-service rate, the median is $3.31. Indiana pays the most ($5.93 per unit) and Ohio the least ($0.60 per Each).
Which state pays the highest Medicaid rate for B4103?
Indiana, at $5.93 per unit, effective 2026-01-01.
Do managed-care plans pay the same rate for B4103?
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
A7000Canister, disposable, used with suction pump, each · 32 statesA8001Helmet, protective, hard, prefabricated · 32 statesB9002Enteral nutrition infusion pump, any type · 32 statesE0105Cane, quad or three prong, includes canes of all materials · 32 statesE0130Walker, rigid (pickup), adjustable or fixed height · 32 statesE0135Walker, folding (pickup), adjustable or fixed height · 32 statesE0143Walker, folding, wheeled, adjustable or fixed height · 32 statesE0149Walker, heavy duty, wheeled, rigid or folding, any type · 32 statesE0155Wheel attachment, rigid pick-up walker, per pair · 32 statesE0163Commode chair, mobile or stationary, with fixed arms · 32 statesE0184Dry pressure mattress · 32 statesE0185Gel or gel-like pressure pad for mattress · 32 states
Track B4103 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.