Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L0484. 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
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Publishing states
44
Median % of Medicare
72.9%
Rate range
$1,002.92 - $2,722.85
L0484 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $1,146.17 | 50.6% | -- | 2026 |
| Arkansas | $1,577.80* | 69.6% | -- | 2026 |
| Arizona | $2,222.06 | 98% | -- | 2026 |
| California | $1,250.29 | 55.1% | -- | 2026 |
| Colorado | $1,937.90 | 85.5% | Required | 2026 |
| Connecticut | $1,502.24 | 66.3% | Required | 2013 |
| District of Columbia | $1,633.71 | 72.1% | Required | 2026 |
| Florida | $1,229.38 | 54.2% | -- | 2026 |
| Hawaii | $1,002.92 | 44.2% | -- | 2025 |
| Iowa | $1,425.87 | 62.9% | -- | 2025 |
| Idaho | $1,764.41 | 77.8% | Not required | 2026 |
| Illinois | $1,819.63 | 80.3% | -- | 2026 |
| Indiana | $2,195.36 | 96.8% | -- | 2026 |
| Kansas | $1,652.48 | 72.9% | -- | 2026 |
| Kentucky | $1,366.56 | 60.3% | -- | 2026 |
| Louisiana | $1,108.61 | 48.9% | -- | 2026 |
| Massachusetts | $2,388.39 | 105.3% | -- | 2026 |
| Maryland | $1,735.82 | 76.6% | Required | 2026 |
| Maine | $2,722.85 | 120.1% | -- | 2026 |
| Michigan | $1,657.06 | 73.1% | -- | 2026 |
| Minnesota | $2,239.27 | 98.8% | Conditional | 2026 |
| Missouri | $1,394.02* | 61.5% | Not required | 2019 |
| Mississippi | $1,749.70* | 77.2% | -- | 2026 |
| Montana | $2,453.84 | 108.2% | Required | 2026 |
| North Carolina | $1,419.78 | 62.6% | -- | 2025 |
| North Dakota | $2,378.92 | 104.9% | Required | 2026 |
| Nebraska | $1,773.59 | 78.2% | -- | 2026 |
| New Hampshire | $2,346.21 | 103.5% | Not required | 2026 |
| New Jersey | $1,531.12 | 67.5% | Not required | 2026 |
| New Mexico | $2,002.10 | 88.3% | -- | 2025 |
| Nevada | $1,850.70 | 81.6% | -- | 2017 |
| New York | $1,447.16 | 63.8% | -- | 2026 |
| Ohio | $1,164.14 | 51.3% | -- | 2010 |
| Oklahoma | $1,429.50 | 63% | -- | 2026 |
| Pennsylvania | $1,337.75 | 59% | -- | 2004 |
| South Carolina | $1,766.99 | 77.9% | -- | 2024 |
| Texas | $1,337.75* | 59% | -- | 2003 |
| Utah | $1,756.09* | 77.5% | Not required | 2026 |
| Virginia | $1,837.93 | 81.1% | -- | 2026 |
| Vermont | $2,282.40 | 100.7% | -- | 2026 |
| Washington | $1,534.82 | 67.7% | -- | 2026 |
| Wisconsin | $1,481.57 | 65.3% | -- | 2008 |
| West Virginia | $1,633.71 | 72.1% | -- | 2026 |
| Wyoming | $1,510.91 | 66.6% | Required | 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
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- 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 80 codes from L0112 to L0984 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L0484?
44 state Medicaid programs publish a fee-for-service rate for L0484 (tlso, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or cad-cam model, custom fabricated), ranging from $1,002.92 in Hawaii to $2,722.85 in Maine, with a median of 72.9% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for L0484?
Maine publishes the highest Medicaid rate for L0484 at $2,722.85 (120.1% of the national Medicare amount). Hawaii publishes the lowest at $1,002.92.
Does L0484 require prior authorization under Medicaid?
8 of the 44 publishing states flag L0484 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".