Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A6404. 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
26
Median % of Medicare
--
Rate range
$0.01 - $3.99
A6404 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $2.31 | -- | -- | 2026 |
| Colorado | $0.79 | -- | Required | 2026 |
| Connecticut | $3.99 | -- | -- | 2003 |
| District of Columbia | $0.60 | -- | Not required | 1997 |
| Delaware | $0.41 | -- | -- | 2026 |
| Hawaii | $0.46 | -- | -- | 2025 |
| Idaho | $0.56 | -- | Not required | 2025 |
| Indiana | $1.53 | -- | -- | 2026 |
| Kansas | $1.00 | -- | -- | 2007 |
| Kentucky | $2.06 | -- | -- | 2026 |
| Louisiana | $0.67 | -- | -- | 2026 |
| Maryland | $0.57 | -- | -- | 2026 |
| Maine | $0.08 | -- | -- | 2026 |
| Michigan | $0.64 | -- | -- | 2026 |
| Minnesota | $0.61 | -- | Conditional | 2025 |
| Missouri | $0.01 | -- | Not required | 2003 |
| North Carolina | $0.46 | -- | -- | 2025 |
| North Dakota | $1.36 | -- | Not required | 2026 |
| New York | $0.36 | -- | -- | 2026 |
| Ohio | $0.61 | -- | -- | 2006 |
| Oklahoma | $0.21 | -- | -- | 2020 |
| Texas | $0.61* | -- | -- | 2017 |
| Virginia | $0.70 | -- | -- | 2010 |
| Washington | $1.53 | -- | -- | 2026 |
| West Virginia | $2.16 | -- | -- | 2026 |
| Wyoming | $0.98 | -- | -- | 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
- 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 171 codes from A6010 to A6610 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for A6404?
26 state Medicaid programs publish a fee-for-service rate for A6404 (gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing), ranging from $0.01 in Missouri to $3.99 in Connecticut. The full table on this page lists every publishing state's current rate.
Which state pays the most for A6404?
Connecticut publishes the highest Medicaid rate for A6404 at $3.99. Missouri publishes the lowest at $0.01.
Does A6404 require prior authorization under Medicaid?
2 of the 26 publishing states flag A6404 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".