E0243 Medicaid reimbursement rates by state
Toilet rail, each. 20 state Medicaid programs publish a fee-for-service rate for E0243 at the nurse midwife level. Rates run from $5.20 in Connecticut to $58.43 in Texas, with a median of $35.66.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 20
- Median rate
- $35.66units vary by state
- Highest
- $58.43Texas
- Medicare (non-facility)
- —not on the physician fee schedule
E0243 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 |
|---|---|---|---|---|---|---|
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $58.43since 2026-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Dmepo |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $53.83since 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) | $46.22since 2021-09-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $42.76since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $40.00since 1999-04-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $40.00since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $39.50since 2012-09-29 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $38.14since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $36.38since 2023-06-01 | — | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2023Medica |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $36.23since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $35.09since 2022-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $33.10since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | DME Fee Schedule - Excel.xlsx |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $32.87since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $32.57since 2003-10-16 | — | — | Not classified | — | SCDHHS Durable Medical Equipment (DME) F |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $29.48since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2024-01- |
| ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $28.70since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $17.72since 2008-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Durable |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $15.00since 2020-08-01 | — | — | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $7.15since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $5.20since 2004-07-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - DME |
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 E0243?
It depends on the state. Of the 20 states with a published fee-for-service rate, the median is $35.66. Texas pays the most ($58.43) and Connecticut the least ($5.20).
Which state pays the highest Medicaid rate for E0243?
Texas, at $58.43, effective 2026-09-01.
Do managed-care plans pay the same rate for E0243?
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 E0243 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.