L5636 Medicaid reimbursement rates by state
Addition to lower extremity, symes type. 32 state Medicaid programs publish a fee-for-service rate for L5636 at the nurse midwife level. Rates run from $101.70 in Pennsylvania to $364.82 in Massachusetts, with a median of $231.82.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 32
- Median rate
- $231.82units vary by state
- Highest
- $364.82Massachusetts
- Medicare (non-facility)
- —not on the physician fee schedule
L5636 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) | $364.82since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Rates for Prostheses, Prosthetic Devices |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $316.91since 2026-01-01 | — | — | 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) | $310.70since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $309.19since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $294.76since 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) | $291.14since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $289.23since 2021-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Prosthetics and orthotics fee schedu |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $285.43since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $271.13since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $265.15since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid DME/DMS/Oxygen, Prosth |
| ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $261.34since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $252.62since 2026-07-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $252.02since 2024-07-01 | — | — | Not classified | — | SCDHHS Durable Medical Equipment (DME) F |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $241.01since 2025-06-04 | — | — | Not classified | — | Arkansas Medicaid Prosthetics (includes |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $234.51since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $234.18since 2022-04-20 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2022-04- |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $229.46since 2013-03-01 | — | — | 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) | $218.36since 2026-01-01 | — | — | Plans must pay at least this | — | SoonerCare Durable Medical Equipment Rat |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $209.67since 2008-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Durable |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $202.50 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Orthotics and |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $199.26since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Durable Medic |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $194.91since 2020-01-01 | — | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2020Medica |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $170.50since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | Orthotic and Prosthetic Fee Schedule - E |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $169.34since 2012-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Durable Medical Equip |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $166.63since 1992-04-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Prost |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $164.75since 2010-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $163.47since 2026-05-20 | — | — | Not classified | — | EPSDT Referral (DME) Fee Schedule (REF-0 |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $149.00since 1990-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $138.40since 2025-07-01 | — | — | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $127.44since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Durable Medical Equipment and Medical Su |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $113.17since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $101.70since 2014-04-19 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
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 L5636?
It depends on the state. Of the 32 states with a published fee-for-service rate, the median is $231.82. Massachusetts pays the most ($364.82) and Pennsylvania the least ($101.70).
Which state pays the highest Medicaid rate for L5636?
Massachusetts, at $364.82, effective 2026-07-01.
Do managed-care plans pay the same rate for L5636?
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 L5636 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.