Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A4269. 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
19
Median % of Medicare
--
Rate range
$1.13 - $52.07
A4269 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| California | $14.99 | -- | -- | 2026 |
| Colorado | $11.43 | -- | -- | 2026 |
| Connecticut | $8.61 | -- | -- | 2026 |
| Kansas | $7.00 | -- | -- | 2013 |
| Kentucky | $5.00 | -- | -- | 2026 |
| Louisiana | $2.42 | -- | -- | 2026 |
| Massachusetts | $4.10 | -- | -- | 2025 |
| Michigan | $4.95 | -- | -- | 2026 |
| Minnesota | $9.28 | -- | Conditional | 2006 |
| Montana | $52.07 | -- | -- | 2026 |
| New Hampshire | $14.88 | -- | Not required | 2026 |
| New Mexico | $3.68 | -- | -- | 2025 |
| Nevada | $1.13 | -- | -- | -- |
| Ohio | $10.05 | -- | -- | 2003 |
| Oklahoma | $5.09 | -- | -- | 2020 |
| South Carolina | $5.58 | -- | -- | 2011 |
| Texas | $12.26* | -- | -- | 2010 |
| Virginia | $12.80 | -- | -- | 2009 |
| Wisconsin | $12.26 | -- | -- | 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 A4269?
19 state Medicaid programs publish a fee-for-service rate for A4269 (contraceptive supply, spermicide (e.g., foam, gel), each), ranging from $1.13 in Nevada to $52.07 in Montana. The full table on this page lists every publishing state's current rate.
Which state pays the most for A4269?
Montana publishes the highest Medicaid rate for A4269 at $52.07. Nevada publishes the lowest at $1.13.
Does A4269 require prior authorization under Medicaid?
1 of the 19 publishing states flag A4269 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".