Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A4284. 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
16
Median % of Medicare
--
Rate range
$1.83 - $16.89
A4284 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Colorado | $10.32 | -- | Required | 2026 |
| Connecticut | $14.54 | -- | -- | 2022 |
| Iowa | $3.17 | -- | -- | 2024 |
| Idaho | $16.56 | -- | Not required | 2025 |
| Illinois | $3.38 | -- | -- | 2026 |
| Louisiana | $8.00 | -- | -- | 2026 |
| Maine | $8.82 | -- | -- | 2026 |
| Michigan | $1.83 | -- | -- | 2026 |
| Missouri | $13.30* | -- | Not required | 2025 |
| New Hampshire | $14.88 | -- | Not required | 2026 |
| Nevada | $9.09 | -- | -- | 2025 |
| Ohio | $8.85 | -- | Not required | 2022 |
| Pennsylvania | $16.89 | -- | -- | 2008 |
| Texas | $9.09* | -- | -- | 2017 |
| Vermont | $7.03 | -- | -- | 2026 |
| Wyoming | $6.58 | -- | -- | 2021 |
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
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- 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 A4284?
16 state Medicaid programs publish a fee-for-service rate for A4284 (breast shield and splash protector for use with breast pump, replacement), ranging from $1.83 in Michigan to $16.89 in Pennsylvania. The full table on this page lists every publishing state's current rate.
Which state pays the most for A4284?
Pennsylvania publishes the highest Medicaid rate for A4284 at $16.89. Michigan publishes the lowest at $1.83.
Does A4284 require prior authorization under Medicaid?
1 of the 16 publishing states flag A4284 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".