Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for E1804. 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
21
Median % of Medicare
--
Rate range
$0.19 - $1,745.80
E1804 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $7.77* | -- | -- | 2026 |
| Colorado | $1,419.03* | -- | Required | 2026 |
| Connecticut | $1,236.67 | -- | -- | 2025 |
| Hawaii | $0.19 | -- | -- | 2025 |
| Idaho | $150.84* | -- | Not required | 2026 |
| Indiana | $1,711.60* | -- | Required | 2025 |
| Massachusetts | $145.49* | -- | -- | 2026 |
| Minnesota | $1,745.80 | -- | Required | 2026 |
| Missouri | $1,711.60* | -- | Not required | 2025 |
| Mississippi | $3.96* | -- | -- | 2026 |
| Montana | $1,745.80 | -- | Not required | 2026 |
| New Jersey | $848.69 | -- | Required | 2026 |
| New Mexico | $145.49 | -- | -- | 2025 |
| Nevada | $171.16* | -- | -- | 2025 |
| Ohio | $1,369.28 | -- | -- | 2026 |
| Oklahoma | $148.39 | -- | -- | 2026 |
| Pennsylvania | $116.39* | -- | -- | 2025 |
| Texas | $1,447.29* | -- | -- | 2025 |
| Virginia | $5.24 | -- | -- | 2026 |
| Vermont | $1,306.16 | -- | -- | 2026 |
| Wisconsin | $1,745.80 | -- | -- | 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 125 codes from E1002 to E1841 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for E1804?
21 state Medicaid programs publish a fee-for-service rate for E1804 (dynamic adjustable elbow flexion only device, includes soft interface material), ranging from $0.19 in Hawaii to $1,745.80 in Minnesota. The full table on this page lists every publishing state's current rate.
Which state pays the most for E1804?
Minnesota publishes the highest Medicaid rate for E1804 at $1,745.80. Hawaii publishes the lowest at $0.19.
Does E1804 require prior authorization under Medicaid?
4 of the 21 publishing states flag E1804 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".