B4224 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 41 of the 43 states publish B4224 per day, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 12 of the 43 states list more than one rate for B4224, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 43 states, 41 publish B4224 per day, 1 per one/day and 1 per unit.
• Per hour. B4224 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for B4224, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for B4224 run from $7.13 in Utah to $687.89 in Kentucky, a 96.5x gap in the same unit. Half the states pay more than the median of $28.34 and half pay less. The usual reasons for a spread like this in equipment & supplies rates:

• Some items are priced individually from the manufacturer's price or the supplier's invoice, so fewer states publish a fixed fee.
• Many states set equipment and supply fees as a percentage of the Medicare DMEPOS fee schedule, at different percentages and from different years.
• A single code can carry separate purchase, rental and used-equipment amounts, and states publish different subsets of them.

Timing matters too. 19 states set the current rate for B4224 in 2026 or later, while 15 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For B4224, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 9 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 20 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 14 states is not classified yet.

• Plans negotiate; the published rate applies out of network (20 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (7 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• The state sets the plan rate (2 states). There is little to negotiate on price. Contracting is about network participation, authorization and billing terms.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Kentucky managed care.

B4224 is a HCPCS Level II enteral and parenteral therapy code in the equipment & supplies line, billed mostly by durable medical equipment suppliers, orthotists, prosthetists and pharmacies. B codes cover enteral and parenteral nutrition, supplies and pumps. They are commonly billed per unit of nutrient or per day of supplies, and pumps may be rented or purchased.

Pricing modifiers decide which amount applies: NU for a new purchase, RR for a monthly rental and UE for used equipment. Units follow the code: per item, per pair, per box or per month of rental, so a per-unit comparison only holds when the states use the same unit.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.