V5257 Medicaid reimbursement rates by state
Hearing aid, digital, monaural, bte. 25 state Medicaid programs publish a fee-for-service rate for V5257. Rates run from $32.53 in Wisconsin to $1,903.99 in Iowa, with a median of $559.67.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 25
- Median rate
- $559.67units vary by state
- Highest
- $1,903.99Iowa
- Medicare (non-facility)
- —not on the physician fee schedule
V5257 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 |
|---|---|---|---|---|---|---|
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $1,903.99⚠ over 3× mediansince 2019-05-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #17 AUDIOLOGI |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $1,600.00since 2020-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,470.98since 2026-07-01 | — | — | Not classified | — | Health First Colorado Physician Fee Sche |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $1,325.50since 2020-04-01 | — | — | Plans negotiate; applies out of network | — | Orthotic and Prosthetic Fee Schedule 2nd |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $1,175.00since 2008-01-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $798.93since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Durable |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $733.70since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $727.50since 2010-01-01 | Each | — | Plans negotiate; applies out of network | — | ODM DMEPOS payment schedule (appendix to |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $668.13since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $607.69since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $600.00since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $575.00since 2009-01-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $559.67since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Hearing Services Fee Schedule (AHCA Upda |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $542.10since 2021-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Hearing hardware fee schedule (heari |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $530.22since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $527.75since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $500.00since 2007-05-01 | — | — | Not classified | — | CMAP fee schedule: 7/1/2025 MEDS - Heari |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $478.33since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $450.00since 2023-03-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - DME Code |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $396.64since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Hearing Aid |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $376.00since 2019-07-24 | — | — | Plans negotiate; applies out of network | — | HFS DME Fee Schedule (effective 2019-07- |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $350.00since 2024-04-01 | — | — | Plans must pay at least this | — | Provider Type 23 Hearing Aid Dispenser & |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $340.37since 2022-04-01 | — | — | Plans negotiate; applies out of network | — | eMedNY NYS Medicaid Hearing Aid / Audiol |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $65.00since 2006-03-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $32.53since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Hearing |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 V5257?
It depends on the state. Of the 25 states with a published fee-for-service rate, the median is $559.67. Iowa pays the most ($1,903.99) and Wisconsin the least ($32.53).
Which state pays the highest Medicaid rate for V5257?
Iowa, at $1,903.99, effective 2019-05-01.
Do managed-care plans pay the same rate for V5257?
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 Vision & hearing codes
V2624Polishing/resurfacing of ocular prosthesis · 42 statesV2625Enlargement of ocular prosthesis · 41 states92609Therapy using a communication device · 40 statesV2626Reduction of ocular prosthesis · 40 statesV2628Fabrication and fitting of ocular conformer · 40 statesV2627Scleral cover shell · 39 statesV5264Ear mold/insert, not disposable, any type · 37 statesV5266Battery for use in hearing device · 36 statesV2020Frames, purchases · 35 statesV2100Sphere, single vision, plano to plus or minus 4.00, per lens · 35 statesV2101Sphere, single vision · 35 statesV2102Sphere, single vision · 35 states
Track V5257 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.