L4205 Medicaid reimbursement rates by state
Repair of orthotic device, labor component, per 15 minutes. 29 state Medicaid programs publish a fee-for-service rate for L4205 at the physician psychologist level. Rates run from $7.00 in Louisiana to $42.36 in Washington, with a median of $19.91.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 29
- Median rate
- $19.91units vary by state
- Highest
- $42.36Washington
- Medicare (non-facility)
- —not on the physician fee schedule
L4205 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 |
|---|---|---|---|---|---|---|
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $42.36since 2026-07-01 | 15 min | $169.44 | Plans negotiate; applies out of network | — | HCA Prosthetics and orthotics fee schedu |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $35.00since 2025-06-04 | 15 min | $140.00 | Not classified | — | Arkansas Medicaid Prosthetics (includes |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $29.92since 2026-01-01 | 15 min | $119.68 | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $29.15since 2026-01-01 | 15 min | $116.60 | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $26.93since 2026-01-01 | 15 min | $107.72 | Plans must pay at least this | — | DMAS procedure fee file hcpcmedical.csv |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $25.43since 2026-01-01 | 15 min | $101.72 | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $24.36since 2016-10-01 | 15 min | $97.44 | 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) | $23.94since 2026-07-01 | 15 min | $95.76 | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $22.86since 2026-07-01 | 15 min | $91.44 | Plans negotiate; applies out of network | — | Rates for Prostheses, Prosthetic Devices |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $22.14since 2026-01-01 | 15 min | $88.56 | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $21.25since 2024-10-01 | 15 min | $85.00 | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $20.96since 2026-07-01 | 15 min | $83.84 | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $20.94since 2026-07-01 | 15 min | $83.76 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $20.93since 2026-07-01 | 15 min | $83.72 | Not classified | — | Health First Colorado Physician Fee Sche |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $19.91since 2009-05-01 | 15 min | $79.64 | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Pro |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $19.70since 2020-08-01 | 15 min | $78.80 | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $19.50since 2021-10-01 | 15 min | $78.00 | 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) | $18.18since 2022-06-01 | 15 min | $72.72 | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS 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) | $17.36since 2025-07-01 | 15 min | $69.44 | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $16.69since 2026-05-20 | 15 min | $66.76 | Not classified | — | EPSDT Referral (DME) Fee Schedule (REF-0 |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $16.47since 2026-10-01 | 15 min | $65.88 | 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) | $14.54 | 15 min | $58.16 | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Orthotics and |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $14.07since 2016-07-01 | 15 min | $56.28 | Plans negotiate; applies out of network | — | Orthotic and Prosthetic Fee Schedule - E |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $12.17since 2021-07-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS payment schedule (appendix to |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $11.85since 2024-07-01 | 15 min | $47.40 | Not classified | — | SCDHHS Durable Medical Equipment (DME) F |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $10.82since 2019-07-01 | 15 min | $43.28 | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Durable Medic |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $10.73since 2026-07-01 | 15 min | $42.92 | Plans negotiate; applies out of network | — | Durable Medical Equipment and Medical Su |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $10.00since 2020-01-01 | 15 min | $40.00 | State sets the plan rate | — | KY Medicaid DME fee schedule (2020Medica |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $7.00since 2021-09-01 | 15 min | $28.00 | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
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 L4205?
It depends on the state. Of the 29 states with a published fee-for-service rate, the median is $19.91. Washington pays the most ($42.36 per 15 min) and Louisiana the least ($7.00 per 15 min).
Which state pays the highest Medicaid rate for L4205?
Washington, at $42.36 per 15 min ($169.44 per hour), effective 2026-07-01.
Do managed-care plans pay the same rate for L4205?
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 L4205 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.