T4540 Medicaid reimbursement rates by state
Incontinence product, protective underpad, reusable. 17 state Medicaid programs publish a fee-for-service rate for T4540. Rates run from $3.65 in Connecticut to $22.00 in Indiana, with a median of $9.93.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 17
- Median rate
- $9.93units vary by state
- Highest
- $22.00Indiana
- Medicare (non-facility)
- —not on the physician fee schedule
T4540 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 |
|---|---|---|---|---|---|---|
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $22.00since 2014-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $16.00since 2023-09-15 | — | — | State sets the plan rate | — | KY Medicaid DME fee schedule (2023Medica |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $15.24since 2012-07-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma ADvantage 1915(c) waiver (older adults and adults with physical disabilities) | $14.40since 2024-10-01 | unit | — | Paid by the state, outside plans | — | Reimbursement Rates for Services, ADvant |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $12.30since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $10.91since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $10.85since 2005-10-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $10.00since 2005-01-01 | Each | — | 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) | $9.93since 2025-11-10 | — | — | Plans negotiate; applies out of network | — | Provider Type 33, Durable Medical Equipm |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $9.50since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $8.85since 2023-08-15 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $8.33since 2014-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $7.81since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $7.26since 2022-06-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid DMEPOS Fee Schedule |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $7.10since 2024-07-01 | — | — | State sets the plan rate | — | Iowa Medicaid fee schedule #08 PHARMACY |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $6.82since 2026-03-01 | — | — | Plans negotiate; applies out of network | — | Rates for Durable Medical Equipment, Oxy |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $3.65since 2005-03-01 | — | — | Not classified | — | CMAP fee schedule: 10/01/2026 MEDS - Med |
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 T4540?
It depends on the state. Of the 17 states with a published fee-for-service rate, the median is $9.93. Indiana pays the most ($22.00 per unit) and Connecticut the least ($3.65).
Which state pays the highest Medicaid rate for T4540?
Indiana, at $22.00 per unit, effective 2014-01-01.
Do managed-care plans pay the same rate for T4540?
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.
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Track T4540 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.