Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A4928. 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
$0.53 - $24.16
A4928 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Hawaii | $5.60 | -- | -- | 2025 |
| Iowa | $2.97 | -- | -- | 2024 |
| Idaho | $7.33 | -- | Not required | 2025 |
| Kentucky | $12.00 | -- | -- | 2026 |
| Minnesota | $0.53 | -- | -- | 2008 |
| North Carolina | $17.01 | -- | -- | 2025 |
| New Hampshire | $7.44 | -- | Not required | 2026 |
| Pennsylvania | $19.96 | -- | -- | 2022 |
| Texas | $24.16* | -- | -- | 2015 |
| Utah | $4.00* | -- | Not required | 2020 |
| Wisconsin | $22.96 | -- | -- | 2006 |
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 A4928?
11 state Medicaid programs publish a fee-for-service rate for A4928 (surgical mask, per 20), ranging from $0.53 in Minnesota to $24.16 in Texas. The full table on this page lists every publishing state's current rate.
Which state pays the most for A4928?
Texas publishes the highest Medicaid rate for A4928 at $24.16. Minnesota publishes the lowest at $0.53.
Does A4928 require prior authorization under Medicaid?
No publishing state flags A4928 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.