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L6638 Medicaid reimbursement rates by state

Upper extremity addition to prosthesis. 39 state Medicaid programs publish a fee-for-service rate for L6638 at the nurse midwife level. Rates run from $1,575.05 in California to $3,606.59 in Alaska, with a median of $2,357.25.

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

States publishing
39
Median rate
$2,357.25units vary by state
Highest
$3,606.59Alaska
Medicare (non-facility)
—not on the physician fee schedule

L6638 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
AlaskaAny qualified provider (rate does not vary by provider) · Alaska Medicaid (fee-for-service, Department of Health)$3,606.59since 2026-01-01——Not classified—Alaska Medicaid DMEPOS Interim Fee Sched
MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service)$3,113.07since 2026-01-01——Not classified—Montana Healthcare Programs fee schedule
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$3,079.31since 2026-01-01——Plans negotiate; applies out of network—MHCP Fee Schedule - Current Fee Schedule
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$3,034.99since 2025-01-01——Plans must pay at least this—New Mexico Medicaid Fee for Service HCPC
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$3,018.93since 2026-01-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$3,005.49since 2026-01-01——Not classified—MaineCare Section 60, Medical Supplies a
DelawareAny qualified provider (rate does not vary by provider) · Delaware Medicaid (fee-for-service, DMMA / DMAP)$3,005.49since 2026-01-01——Plans negotiate; applies out of network—DMAP 2026 DME Fee Schedule
HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service$2,946.56since 2026-06-01——Plans negotiate; applies out of network—Medicaid Fee-For-Service (FFS) Fee Sched
South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services)$2,801.76since 2026-01-01——Not classified—South Dakota Medicaid DME fee schedule (
MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations)$2,636.31since 2026-07-01——Plans negotiate; applies out of network—Rates for Prostheses, Prosthetic Devices
New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS)$2,589.75since 2024-07-01——Not classified—2026 Fee Schedule - Covered Procedures R
MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH)$2,554.67since 2026-01-01——Not classified—Maryland Medicaid DME/DMS/Oxygen, Prosth
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$2,519.31since 2026-01-01——Not classified—Vermont Medicaid Fee Schedule - DME Code
ArizonaCertified nurse-midwife · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$2,518.03since 2026-10-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Durable
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$2,501.26since 2024-07-01——Not classified—SCDHHS Durable Medical Equipment (DME) F
KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule)$2,451.37since 2026-07-01——Paid by the state, outside plans—KMAP Fee Schedule MKN Medicaid (FeeSched
West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services)$2,404.39since 2026-04-01——Plans must pay at least this—BMS DME 2026 Rural Fee Schedule Effectiv
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$2,391.79since 2025-06-04——Not classified—Arkansas Medicaid Prosthetics (includes
ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP)$2,371.41since 2026-07-01——Plans negotiate; applies out of network—Child Health Plan Plus FY 2026-2027 Fee
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$2,357.25since 2026-01-01——Plans negotiate; applies out of network—ODM DMEPOS combined payment schedules (a
NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules)$2,331.42since 2017-01-01——Plans negotiate; applies out of network—Provider Type 33, Durable Medical Equipm
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$2,265.24since 2012-01-01——Plans negotiate; applies out of network—DMAS procedure fee file hcpcmedical.csv
WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service$2,258.85since 2021-07-01——Plans negotiate; applies out of network—HCA Prosthetics and orthotics fee schedu
UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan)$2,227.87since 2026-07-01——Plans negotiate; applies out of network—Utah Medicaid Coverage and Reimbursement
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$2,166.98since 2026-01-01——Plans must pay at least this—SoonerCare Durable Medical Equipment Rat
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$2,103.84since 2026-07-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$2,072.06since 2024-07-01——State sets the plan rate—Iowa Medicaid fee schedule #08 PHARMACY
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$2,037.32since 2008-07-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Durable
TexasAny qualified provider (rate does not vary by provider) · Texas Medicaid (fee-for-service, TMHP)$2,027.88since 2003-06-01——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)$2,009.78——Plans negotiate; applies out of network—NC Medicaid fee schedule 'Orthotics and
WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health)$1,988.30since 2021-01-01——Not classified—Wyoming Medicaid Downloadable Fee Schedu
PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service)$1,968.81since 2004-01-01——Plans negotiate; applies out of network—PA DHS PROMISe Outpatient Fee Schedule (
Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service)$1,936.78since 2012-07-01——Plans negotiate; applies out of network—RI Medicaid Interactive Fee For Service
KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules)$1,903.77since 2020-01-01——State sets the plan rate—KY Medicaid DME fee schedule (2020Medica
New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service)$1,789.65since 2022-06-01——Plans negotiate; applies out of network—eMedNY NYS Medicaid DMEPOS Fee Schedule
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$1,785.50since 2013-03-01——Not classified—CMAP fee schedule: 10/01/2026 MEDS - Pro
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$1,692.24since 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)$1,622.47since 2026-05-20——Not classified—EPSDT Referral (DME) Fee Schedule (REF-0
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$1,575.05since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d

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 L6638?

It depends on the state. Of the 39 states with a published fee-for-service rate, the median is $2,357.25. Alaska pays the most ($3,606.59) and California the least ($1,575.05).

Which state pays the highest Medicaid rate for L6638?

Alaska, at $3,606.59, effective 2026-01-01.

Do managed-care plans pay the same rate for L6638?

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
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Medicaid rates by state
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