S5498 Medicaid reimbursement rates by state
Home infusion therapy, catheter care / maintenance, simple. 7 state Medicaid programs publish a fee-for-service rate for S5498. Rates run from $3.94 in Michigan to $13.95 in Massachusetts, with a median of $7.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $7.00per day
- Highest
- $13.95Massachusetts
- Medicare (non-facility)
- —not on the physician fee schedule
S5498 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) | $13.95since 2026-03-01 | day | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $12.04since 2025-01-01 | day | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2025-01- |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $10.00since 2022-01-01 | day | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2022Medica |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $7.00since 2026-05-27 | day | — | Not classified | — | DME/POP Fee Schedule (REF-0132-Q) |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $6.38since 2012-07-01 | day | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $4.86since 2012-01-01 | day | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $3.94since 2023-01-01 | day | — | Plans negotiate; applies out of network | — | MDHHS Medical Suppliers/Orthotists/Prost |
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 S5498?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $7.00 per day. Massachusetts pays the most ($13.95 per day) and Michigan the least ($3.94 per day).
Which state pays the highest Medicaid rate for S5498?
Massachusetts, at $13.95 per day, effective 2026-03-01.
Do managed-care plans pay the same rate for S5498?
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.