E0486 Medicaid reimbursement rates by state
Oral device/appliance used to reduce upper airway.... 9 state Medicaid programs publish a fee-for-service rate for E0486 at the nurse midwife level. Rates run from $10.00 in Kansas to $1,881.22 in Massachusetts, with a median of $1,374.30.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 9
- Median rate
- $1,374.30units vary by state
- Highest
- $1,881.22Massachusetts
- Medicare (non-facility)
- —not on the physician fee schedule
E0486 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 |
|---|---|---|---|---|---|---|
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $1,881.22since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $1,454.35since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $1,442.09since 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) | $1,435.67since 2024-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #12 MEDICAL S |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $1,374.30since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | HCA Sleep centers fee schedule (sleep-ce |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $1,250.00since 2024-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $602.38since 2016-07-01 | — | — | Paid by the state, outside plans | — | ForwardHealth max fee schedule: Dental ( |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $372.81since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $10.00since 2006-01-01 | — | — | 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 E0486?
It depends on the state. Of the 9 states with a published fee-for-service rate, the median is $1,374.30. Massachusetts pays the most ($1,881.22) and Kansas the least ($10.00).
Which state pays the highest Medicaid rate for E0486?
Massachusetts, at $1,881.22, effective 2026-03-01.
Do managed-care plans pay the same rate for E0486?
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.