Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A4255. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
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Publishing states
21
Median % of Medicare
88.7%
Rate range
$1.05 - $15.95
A4255 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $7.00 | 121.3% | -- | 2026 |
| Colorado | $4.69 | 81.3% | -- | 2026 |
| Connecticut | $3.49 | 60.5% | -- | 2007 |
| District of Columbia | $4.46 | 77.3% | Not required | 2026 |
| Delaware | $5.58 | 96.7% | -- | 2026 |
| Hawaii | $4.30 | 74.5% | -- | 2025 |
| Iowa | $1.05 | 18.2% | -- | 2024 |
| Indiana | $5.74 | 99.5% | -- | 2026 |
| Kansas | $4.68 | 81.1% | -- | 2026 |
| Maryland | $4.74 | 82.1% | -- | 2026 |
| Maine | $5.58 | 96.7% | -- | 2026 |
| Minnesota | $5.85 | 101.4% | Conditional | 2026 |
| Montana | $5.85 | 101.4% | Not required | 2026 |
| North Dakota | $5.72 | 99.1% | Not required | 2026 |
| Nebraska | $5.12 | 88.7% | -- | 2026 |
| New Hampshire | $15.95 | 276.4% | Not required | 2026 |
| New Mexico | $5.74 | 99.5% | -- | 2025 |
| Ohio | $4.37 | 75.7% | -- | 2026 |
| Vermont | $4.68 | 81.1% | -- | 2026 |
| Washington | $4.41 | 76.4% | -- | 2026 |
| Wyoming | $5.27* | 91.3% | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related dme & supplies codes
- A2001 - Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure)
- A2002 - Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2005 - Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2006 - Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2007 - Restrata, per square centimeter (add-on, list separately in addition to primary procedure)
- A2008 - Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure)
- A2009 - Symphony, per square centimeter (add-on, list separately in addition to primary procedure)
- A2010 - Apis, per square centimeter (add-on, list separately in addition to primary procedure)
All 238 codes from A4206 to A4932 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for A4255?
21 state Medicaid programs publish a fee-for-service rate for A4255 (platforms for home blood glucose monitor, 50 per box), ranging from $1.05 in Iowa to $15.95 in New Hampshire, with a median of 88.7% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for A4255?
New Hampshire publishes the highest Medicaid rate for A4255 at $15.95 (276.4% of the national Medicare amount). Iowa publishes the lowest at $1.05.
Does A4255 require prior authorization under Medicaid?
1 of the 21 publishing states flag A4255 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".