Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for E0658. 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
15
Median % of Medicare
--
Rate range
$4.21 - $1,753.60
E0658 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $7.96* | -- | -- | 2026 |
| Colorado | $1,346.91* | -- | Required | 2026 |
| Connecticut | $1,492.90 | -- | Required | 2025 |
| Idaho | $154.79 | -- | Required | 2026 |
| Indiana | $1,492.90* | -- | -- | 2025 |
| Minnesota | $1,522.80 | -- | Required | 2026 |
| Mississippi | $4.21* | -- | -- | 2026 |
| Montana | $152.28* | -- | Not required | 2026 |
| New Jersey | $122.23 | -- | Required | 2026 |
| Nevada | $1,753.60* | -- | -- | 2025 |
| Ohio | $1,440.66 | -- | -- | 2025 |
| Utah | $1,258.90* | -- | Required | 2026 |
| Virginia | $1,439.05 | -- | -- | 2026 |
| Vermont | $1,340.27 | -- | -- | 2026 |
| Washington | $150.80* | -- | -- | 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 295 codes from E0100 to E0995 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for E0658?
15 state Medicaid programs publish a fee-for-service rate for E0658 (segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest), ranging from $4.21 in Mississippi to $1,753.60 in Nevada. The full table on this page lists every publishing state's current rate.
Which state pays the most for E0658?
Nevada publishes the highest Medicaid rate for E0658 at $1,753.60. Mississippi publishes the lowest at $4.21.
Does E0658 require prior authorization under Medicaid?
6 of the 15 publishing states flag E0658 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".