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Q4122 Medicaid reimbursement rates by state

Dermacell, dermacell awm or dermacell awm porous. 6 state Medicaid programs publish a fee-for-service rate for Q4122. Rates run from $50.55 in Indiana to $137.06 in Connecticut, with a median of $82.32.

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

States publishing
6
Median rate
$82.32units vary by state
Highest
$137.06Connecticut
Medicare (non-facility)
$116.19–$137.062026 physician fee schedule

Q4122 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
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$137.06since 2026-07-01——Not classified—CMAP fee schedule: Physician Office and
ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$110.00since 2025-07-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Physicia
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$83.49since 2026-01-01——Not classified—SCDHHS Pediatric Subspecialty and Neonat
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$81.15since 2026-01-01——Plans negotiate; applies out of network—MDHHS Oral Maxillofacial Surgeon Fee Sch
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$79.13since 2026-01-01——Plans negotiate; applies out of network—HFS Practitioner Fee Schedule (effective
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$50.55since 2026-01-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd

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 Q4122?

It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $82.32. Connecticut pays the most ($137.06) and Indiana the least ($50.55 per unit).

Which state pays the highest Medicaid rate for Q4122?

Connecticut, at $137.06, effective 2026-07-01.

Do managed-care plans pay the same rate for Q4122?

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

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Medicaid rates by state