Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L3904. 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
37
Median % of Medicare
74.4%
Rate range
$1,715.16 - $4,390.61
L3904 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $2,157.12* | 57.5% | -- | 2026 |
| Arizona | $4,089.29 | 109% | -- | 2026 |
| California | $2,049.88 | 54.6% | -- | 2026 |
| Colorado | $1,745.99 | 46.5% | -- | 2026 |
| Delaware | $3,292.96 | 87.8% | -- | 2026 |
| Florida | $2,087.41 | 55.6% | -- | 2026 |
| Hawaii | $2,508.92 | 66.9% | -- | 2025 |
| Iowa | $2,040.48 | 54.4% | -- | 2024 |
| Idaho | $2,845.11 | 75.8% | Not required | 2026 |
| Indiana | $3,701.21 | 98.6% | -- | 2026 |
| Kansas | $2,634.37 | 70.2% | -- | 2026 |
| Kentucky | $2,505.44 | 66.8% | -- | 2026 |
| Louisiana | $1,787.64 | 47.6% | -- | 2026 |
| Massachusetts | $3,039.43 | 81% | -- | 2026 |
| Maryland | $2,799.02 | 74.6% | Required | 2026 |
| Maine | $3,465.07 | 92.3% | -- | 2026 |
| Michigan | $2,793.67 | 74.4% | -- | 2026 |
| Minnesota | $3,775.23 | 100.6% | Required | 2026 |
| Mississippi | $3,207.85* | 85.5% | -- | 2026 |
| Montana | $4,390.61 | 117% | Required | 2026 |
| North Carolina | $2,603.00 | 69.4% | -- | 2025 |
| Nebraska | $2,827.42 | 75.3% | -- | 2026 |
| New Hampshire | $2,985.76 | 79.6% | Not required | 2026 |
| New Jersey | $2,305.07 | 61.4% | Not required | 2026 |
| New Mexico | $3,228.39 | 86% | -- | 2025 |
| Nevada | $3,405.88 | 90.8% | -- | 2017 |
| Ohio | $2,582.71 | 68.8% | -- | 2026 |
| Oklahoma | $2,305.07 | 61.4% | -- | 2026 |
| South Carolina | $3,239.54 | 86.3% | -- | 2024 |
| Texas | $1,715.16* | 45.7% | -- | 1993 |
| Utah | $3,142.14* | 83.7% | Required | 2026 |
| Virginia | $2,963.66 | 79% | -- | 2026 |
| Vermont | $2,904.55 | 77.4% | -- | 2026 |
| Washington | $2,474.91 | 66% | -- | 2026 |
| Wisconsin | $1,998.17 | 53.2% | -- | 2008 |
| West Virginia | $2,634.37 | 70.2% | -- | 2026 |
| Wyoming | $2,703.43 | 72% | 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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- 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 150 codes from L3000 to L3995 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L3904?
37 state Medicaid programs publish a fee-for-service rate for L3904 (wrist hand finger orthosis, external powered, electric, custom fabricated), ranging from $1,715.16 in Texas to $4,390.61 in Montana, with a median of 74.4% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for L3904?
Montana publishes the highest Medicaid rate for L3904 at $4,390.61 (117% of the national Medicare amount). Texas publishes the lowest at $1,715.16.
Does L3904 require prior authorization under Medicaid?
5 of the 37 publishing states flag L3904 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".