Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L0623. 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
34
Median % of Medicare
98.8%
Rate range
$9.68 - $247.10
L0623 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $247.10* | 194% | -- | 2026 |
| Arizona | $119.61 | 93.9% | -- | 2026 |
| Colorado | $55.01 | 43.2% | -- | 2026 |
| Florida | $36.48 | 28.6% | -- | 2026 |
| Hawaii | $9.68 | 7.6% | -- | 2025 |
| Iowa | $105.88 | 83.1% | -- | 2024 |
| Idaho | $150.93 | 118.5% | Not required | 2026 |
| Indiana | $69.18 | 54.3% | -- | 2026 |
| Kansas | $107.55 | 84.4% | -- | 2026 |
| Kentucky | $144.16 | 113.2% | -- | 2026 |
| Maryland | $102.27 | 80.3% | -- | 2026 |
| Maine | $174.69 | 137.1% | -- | 2026 |
| Michigan | $131.21 | 103% | -- | 2026 |
| Minnesota | $134.44 | 105.5% | Conditional | 2026 |
| Missouri | $58.96* | 46.3% | Not required | 2019 |
| Mississippi | $142.33* | 111.7% | -- | 2026 |
| Montana | $178.51 | 140.1% | Not required | 2026 |
| North Carolina | $194.08 | 152.4% | -- | 2025 |
| Nebraska | $191.07 | 150% | -- | 2026 |
| New Hampshire | $116.68 | 91.6% | Not required | 2026 |
| New Jersey | $84.22 | 66.1% | Not required | 2026 |
| New Mexico | $125.91 | 98.8% | -- | 2025 |
| Nevada | $56.83 | 44.6% | -- | 2011 |
| New York | $214.62 | 168.5% | -- | 2026 |
| Ohio | $47.06 | 36.9% | -- | 2026 |
| Oklahoma | $124.53 | 97.8% | -- | 2026 |
| Pennsylvania | $142.51 | 111.9% | -- | 2007 |
| Texas | $138.61* | 108.8% | -- | 2023 |
| Utah | $48.09* | 37.8% | Not required | 2026 |
| Virginia | $132.07 | 103.7% | -- | 2023 |
| Vermont | $146.04 | 114.6% | -- | 2026 |
| Washington | $58.29 | 45.8% | -- | 2026 |
| West Virginia | $139.75 | 109.7% | -- | 2026 |
| Wyoming | $78.89 | 61.9% | Required | 2025 |
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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- 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 80 codes from L0112 to L0984 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L0623?
34 state Medicaid programs publish a fee-for-service rate for L0623 (sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf), ranging from $9.68 in Hawaii to $247.10 in Arkansas, with a median of 98.8% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for L0623?
Arkansas publishes the highest Medicaid rate for L0623 at $247.10 (194% of the national Medicare amount). Hawaii publishes the lowest at $9.68.
Does L0623 require prior authorization under Medicaid?
2 of the 34 publishing states flag L0623 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".