L3257 Medicaid reimbursement rates by state
Orthopedic footwear, additional charge for split size. 29 state Medicaid programs publish a fee-for-service rate for L3257 at the nurse midwife level. Rates run from $8.55 in Hawaii to $241.45 in South Dakota, with a median of $44.10.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 29
- Median rate
- $44.10units vary by state
- Highest
- $241.45South Dakota
- Medicare (non-facility)
- —not on the physician fee schedule
L3257 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 |
|---|---|---|---|---|---|---|
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $241.45⚠ over 3× mediansince 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid DME fee schedule ( |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $193.60⚠ over 3× mediansince 2018-09-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #05 PODIATRIS |
| WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health) | $177.45⚠ over 3× mediansince 2021-01-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $138.57since 2010-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $95.83since 2020-01-01 | — | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2020Medica |
| AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health) | $78.00since 2025-10-01 | — | — | Not classified | — | Alaska Medicaid DMEPOS Interim Fee Sched |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $65.47since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $61.82since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $58.08since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $57.66since 2010-07-01 | Each | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $55.54since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $52.95since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $50.00since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $45.39since 2008-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Durable |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $44.10since 2023-03-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $40.00since 2012-07-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $39.20since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $38.37 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Orthotics and |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $32.95since 2025-06-04 | — | — | Not classified | — | Arkansas Medicaid Prosthetics (includes |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $31.10since 2019-07-24 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2019-07- |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $30.95since 2020-08-01 | — | — | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $27.48since 2011-08-01 | — | — | Plans negotiate; applies out of network | — | Provider Type 33, Durable Medical Equipm |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $27.00since 2026-04-01 | — | — | Plans must pay at least this | — | BMS DME 2026 Rural Fee Schedule Effectiv |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $22.50since 2021-03-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Ortho |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $20.00since 2006-04-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $15.00since 2026-05-20 | — | — | Not classified | — | EPSDT Referral (DME) Fee Schedule (REF-0 |
| ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $14.45since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $12.12since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $8.55since 2024-03-04 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 L3257?
It depends on the state. Of the 29 states with a published fee-for-service rate, the median is $44.10. South Dakota pays the most ($241.45) and Hawaii the least ($8.55).
Which state pays the highest Medicaid rate for L3257?
South Dakota, at $241.45, effective 2026-07-01.
Do managed-care plans pay the same rate for L3257?
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
L0120Cervical, flexible, non-adjustable, prefabricated · 48 statesL0130Cervical, flexible, thermoplastic collar, molded to patient · 48 statesL0140Cervical, semi-rigid, adjustable (plastic collar) · 48 statesL0150Cervical, semi-rigid, adjustable molded chin cup · 48 statesL0172Cervical, collar, semi-rigid thermoplastic foam, two-piece · 48 statesL0174Cervical, collar, semi-rigid, thermoplastic foam · 48 statesL0200Cervical, multiple post collar · 48 statesL0220Thoracic, rib belt, custom fabricated · 48 statesL0450Tlso, flexible, provides trunk support · 48 statesL0472Tlso, triplanar control, hyperextension · 48 statesL0482Tlso, triplanar control · 48 statesL0484Tlso, triplanar control · 48 states
Track L3257 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.