B4155 Medicaid Rate by State

Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

33 state Medicaid programs publish a fee-for-service rate for B4155 (enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit), ranging from $0.68 in Michigan to $6.18 in Texas.

Every state, kept current

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This page shows one representative rate per state for B4155. Full schedules include every locality, modifier, and age-band variant.

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Publishing states

33

Median % of Medicare

--

Rate range

$0.68 - $6.18

B4155 rates in every publishing state

StateMedicaid rate% of MedicarePrior authVintage
Arkansas$0.74*----2026
Arizona$1.26----2026
Colorado$3.23--Required2026
District of Columbia$0.90--Required2026
Florida$0.79----2026
Georgia$0.99*----2026
Hawaii$0.87----2025
Iowa$1.04----2024
Idaho$0.98--Not required2026
Illinois$0.85----2026
Indiana$0.86--Required2026
Louisiana$0.82----2026
Massachusetts$0.77*----2026
Maryland$1.19----2026
Maine$1.13----2026
Michigan$0.68----2026
Missouri$0.89*--Not required2018
Montana$1.13--Not required2026
North Carolina$2.55----2025
North Dakota$1.64--Required2026
Nebraska$1.24----2026
New Hampshire$0.89--Not required2026
New Mexico$1.34----2025
Nevada$0.87----2011
New York$1.22----2026
Ohio$1.00----2024
Oklahoma$1.41----2026
Pennsylvania$0.72----2013
South Carolina$0.91----2024
Texas$6.18*----2016
Virginia$1.13----2026
Vermont$0.95----2026
Wisconsin$0.95----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

All 41 codes from B4034 to B4224 or every dme & supplies code by number.

Frequently asked questions

How much does Medicaid pay for B4155?

33 state Medicaid programs publish a fee-for-service rate for B4155 (enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit), ranging from $0.68 in Michigan to $6.18 in Texas. The full table on this page lists every publishing state's current rate.

Which state pays the most for B4155?

Texas publishes the highest Medicaid rate for B4155 at $6.18. Michigan publishes the lowest at $0.68.

Does B4155 require prior authorization under Medicaid?

4 of the 33 publishing states flag B4155 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".