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L5974 Medicaid reimbursement rates by state

All lower extremity prostheses, foot, single axis ankle/foot. 38 state Medicaid programs publish a fee-for-service rate for L5974 at the nurse midwife level. Rates run from $72.86 in Florida to $371.93 in Maine, with a median of $226.37.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
38
Median rate
$226.37units vary by state
Highest
$371.93Maine
Medicare (non-facility)
—not on the physician fee schedule

L5974 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.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$371.93since 2026-01-01——Not classified—MaineCare Section 60, Medical Supplies a
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$328.65since 2026-07-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju
MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations)$326.25since 2026-07-01——Plans negotiate; applies out of network—Rates for Prostheses, Prosthetic Devices
ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$318.69since 2026-10-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Durable
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$318.16since 2025-01-01——Plans must pay at least this—New Mexico Medicaid Fee for Service HCPC
MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH)$309.42since 2026-01-01——Not classified—Maryland Medicaid DME/DMS/Oxygen, Prosth
NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules)$295.07since 2017-01-01——Plans negotiate; applies out of network—Provider Type 33, Durable Medical Equipm
OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA)$291.34since 2024-10-01——Plans negotiate; applies out of network—OHP FFS medical-dental fee schedule (fee
West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services)$291.22since 2026-04-01——Plans must pay at least this—BMS DME 2026 Rural Fee Schedule Effectiv
MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service)$289.27since 2026-01-01——Not classified—Montana Healthcare Programs fee schedule
WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service$285.88since 2021-07-01——Plans negotiate; applies out of network—HCA Prosthetics and orthotics fee schedu
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$285.29since 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)$279.69since 2026-01-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$266.78since 2026-07-01——Plans negotiate; applies out of network—Nebraska Medicaid fee schedule 471-000-5
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$250.73since 2025-06-04——Not classified—Arkansas Medicaid Prosthetics (includes
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$248.57since 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)$230.49since 2024-07-01——Not classified—SCDHHS Durable Medical Equipment (DME) F
MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service)$228.23since 2026-07-01——Plans must pay at least this—DOM Comprehensive Fee Schedule, Septembe
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$227.16since 2026-01-01——Plans must pay at least this—SoonerCare Durable Medical Equipment Rat
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$225.58since 2025-01-01——Plans negotiate; applies out of network—HFS DME Fee Schedule (effective 2025-01-
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$211.11since 2026-01-01——Plans negotiate; applies out of network—MDHHS Medical Suppliers/Orthotists/Prost
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$210.00since 1989-07-01——Plans negotiate; applies out of network—DMAS procedure fee file hcpcmedical.csv
MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service)$207.42since 2019-07-01——Plans negotiate; applies out of network—MO HealthNet fee schedule: Durable Medic
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$205.19since 2013-03-01——Not classified—CMAP fee schedule: 10/01/2026 MEDS - Pro
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$199.70since 2026-07-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP)$193.89since 1992-04-01——Plans negotiate; applies out of network—TMHP Texas Medicaid Fee Schedule - Prost
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$185.19——Plans negotiate; applies out of network—NC Medicaid fee schedule 'Orthotics and
KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules)$178.25since 2020-01-01——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)$176.15since 2012-07-01——Plans must pay at least this—Louisiana Medicaid Durable Medical Equip
IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$172.78since 2025-07-01——State sets the plan rate—Iowa Medicaid fee schedule #08 PHARMACY
ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP)$167.06since 2026-07-01——Plans negotiate; applies out of network—Child Health Plan Plus FY 2026-2027 Fee
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$155.94since 2016-07-01——Plans negotiate; applies out of network—Orthotic and Prosthetic Fee Schedule - E
AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules)$149.50since 2026-05-27——Not classified—DME/POP Fee Schedule (REF-0132-Q)
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$148.31since 2010-01-01Each—Plans negotiate; applies out of network—ODM DMEPOS payment schedule (appendix to
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$143.80since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$128.08since 2008-07-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Durable
New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service)$111.10since 2022-06-01——Plans negotiate; applies out of network—eMedNY NYS Medicaid DMEPOS Fee Schedule
FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service)$72.86since 2026-07-01——Plans negotiate; applies out of network—Durable Medical Equipment and Medical Su

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 L5974?

It depends on the state. Of the 38 states with a published fee-for-service rate, the median is $226.37. Maine pays the most ($371.93) and Florida the least ($72.86).

Which state pays the highest Medicaid rate for L5974?

Maine, at $371.93, effective 2026-01-01.

Do managed-care plans pay the same rate for L5974?

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

A7000Canister, disposable, used with suction pump, each · 39 statesA8001Helmet, protective, hard, prefabricated · 39 statesB9002Enteral nutrition infusion pump, any type · 39 statesE0105Cane, quad or three prong, includes canes of all materials · 39 statesE0130Walker, rigid (pickup), adjustable or fixed height · 39 statesE0135Walker, folding (pickup), adjustable or fixed height · 39 statesE0143Walker, folding, wheeled, adjustable or fixed height · 39 statesE0149Walker, heavy duty, wheeled, rigid or folding, any type · 39 statesE0155Wheel attachment, rigid pick-up walker, per pair · 39 statesE0163Commode chair, mobile or stationary, with fixed arms · 39 statesE0184Dry pressure mattress · 39 statesE0185Gel or gel-like pressure pad for mattress · 39 states
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