E0785 Medicaid reimbursement rate by state (2026)
Implantable intraspinal. Medicaid pays a median of $528.15 for E0785 across 19 states, from $150.62 in Kansas to $702.59 in Arizona.
- States publishing
- 19
- National median
- $528.15units vary by state
- Lowest
- $150.62Kansas
- Highest
- $702.59Arizona
What does Medicaid pay for E0785?
19 state Medicaid programs publish a fee-for-service rate for E0785. The national median is $528.15 (units differ between states). Arizona pays the most, $702.59, and Kansas the least, $150.62, a 4.7x spread.
E0785 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 19 states with every variant, modifier and effective date.
How to read this table
- Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for E0785, so the order is by published amount and is not a like-for-like rank.
- Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 6 of the 19 states list more than one rate for E0785, 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 19 states, 1 publish E0785 per unit, and 18 schedules print no unit at all (a flat amount per service).
- Per hour. E0785 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 E0785, 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.
Why E0785 rates differ between states
Published rates for E0785 run from $150.62 in Kansas to $702.59 in Arizona, a 4.7x gap in the same unit. Half the states pay more than the median of $528.15 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. 13 states set the current rate for E0785 in 2026 or later, while 4 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.
What managed-care plans pay for E0785
What a plan pays for E0785 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 19 states.
In 4 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 10 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 5 states is not classified yet.
- Plans negotiate; the published rate applies out of network (10 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 (4 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.
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 Arizona managed care.
Units and billing for E0785
E0785 is a HCPCS Level II durable medical equipment code in the equipment & supplies line, billed mostly by durable medical equipment suppliers, orthotists, prosthetists and pharmacies. E codes cover durable medical equipment. The same code can carry a purchase price, a monthly rental and a used-equipment price, chosen with a pricing modifier.
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.
Frequently asked questions
What does Medicaid pay for E0785?
It depends on the state. Of the 19 states with a published fee-for-service rate, the median is $528.15. Arizona pays the most ($702.59) and Kansas the least ($150.62).
Which state pays the highest Medicaid rate for E0785?
Arizona, at $702.59, effective 2026-10-01.
Which state pays the lowest Medicaid rate for E0785?
Kansas, at $150.62, effective 2026-07-01.
What unit is E0785 billed in?
Of the 19 states, 1 publish E0785 per unit, and 18 schedules print no unit at all (a flat amount per service).
Do managed-care plans pay the same rate for E0785?
Not necessarily. In 4 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 10 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 5 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.