L5859 Medicaid reimbursement rates by state
Addition to lower extremity prosthesis. 13 state Medicaid programs publish a fee-for-service rate for L5859. Rates run from $10,371.71 in Alabama to $17,866.14 in Minnesota, with a median of $14,493.42.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 13
- Median rate
- $14,493.42units vary by state
- Highest
- $17,866.14Minnesota
- Medicare (non-facility)
- —not on the physician fee schedule
L5859 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 |
|---|---|---|---|---|---|---|
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $17,866.14since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $17,832.34since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Prosthetics and orthotics fee schedu |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $17,515.82since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $17,026.80since 2025-07-01 | — | — | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $15,420.61since 2023-01-01 | — | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2023Medica |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $15,248.38since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2023-01- |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $14,493.42since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | ODM DMEPOS combined payment schedules (a |
| TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP) | $13,782.16since 2014-10-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Prost |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $13,220.94since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $12,206.53since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $11,514.22since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Rates for Prostheses, Prosthetic Devices |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $11,271.00since 2019-03-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Pro |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $10,371.71since 2026-05-20 | — | — | Not classified | — | EPSDT Referral (DME) Fee Schedule (REF-0 |
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 L5859?
It depends on the state. Of the 13 states with a published fee-for-service rate, the median is $14,493.42. Minnesota pays the most ($17,866.14) and Alabama the least ($10,371.71).
Which state pays the highest Medicaid rate for L5859?
Minnesota, at $17,866.14, effective 2026-01-01.
Do managed-care plans pay the same rate for L5859?
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.