Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A4264. 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
$29/mo after the trial. Cancel anytime.
Publishing states
11
Median % of Medicare
--
Rate range
$383.06 - $1,674.00
A4264 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| California | $1,299.00 | -- | -- | 2026 |
| Connecticut | $383.06 | -- | -- | 2026 |
| Kentucky | $1,400.00 | -- | Required | 2026 |
| New Mexico | $1,499.89 | -- | -- | 2025 |
| Nevada | $1,307.25 | -- | -- | 2024 |
| Oklahoma | $1,500.00 | -- | -- | 2020 |
| Pennsylvania | $1,300.00 | -- | -- | 2011 |
| South Carolina | $1,674.00 | -- | -- | 2012 |
| Texas | $1,400.00* | -- | -- | 2025 |
| Utah | $1,346.14* | -- | Required | 2012 |
| Wisconsin | $1,560.00 | -- | -- | 2017 |
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 A4264?
11 state Medicaid programs publish a fee-for-service rate for A4264 (permanent implantable contraceptive intratubal occlusion device(s) and delivery system), ranging from $383.06 in Connecticut to $1,674.00 in South Carolina. The full table on this page lists every publishing state's current rate.
Which state pays the most for A4264?
South Carolina publishes the highest Medicaid rate for A4264 at $1,674.00. Connecticut publishes the lowest at $383.06.
Does A4264 require prior authorization under Medicaid?
2 of the 11 publishing states flag A4264 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".