Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for A9569. 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
13
Median % of Medicare
--
Rate range
$488.55 - $1,953.92
A9569 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $887.42* | -- | -- | 2026 |
| Arizona | $988.30 | -- | -- | 2026 |
| Idaho | $1,688.19 | -- | Not required | 2025 |
| Kentucky | $934.13 | -- | -- | 2026 |
| Michigan | $488.55 | -- | -- | 2026 |
| Minnesota | $1,138.00 | -- | -- | 2012 |
| Missouri | $840.72 | -- | Not required | 2026 |
| Mississippi | $934.13 | -- | -- | 2026 |
| Montana | $1,953.92 | -- | -- | 2026 |
| Nebraska | $1,830.52 | -- | -- | 2026 |
| Nevada | $543.17 | -- | -- | 2024 |
| Oklahoma | $823.36 | -- | -- | 2026 |
| Washington | $1,953.92 | -- | -- | 2026 |
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 76 codes from A9274 to A9800 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for A9569?
13 state Medicaid programs publish a fee-for-service rate for A9569 (technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose), ranging from $488.55 in Michigan to $1,953.92 in Montana. The full table on this page lists every publishing state's current rate.
Which state pays the most for A9569?
Montana publishes the highest Medicaid rate for A9569 at $1,953.92. Michigan publishes the lowest at $488.55.
Does A9569 require prior authorization under Medicaid?
No publishing state flags A9569 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.