Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L5280. 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
43
Median % of Medicare
67.8%
Rate range
$1,600.00 - $8,267.45
L5280 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $3,973.00 | 53% | -- | 2026 |
| Arkansas | $4,680.07* | 62.4% | -- | 2026 |
| Arizona | $7,740.89 | 103.2% | -- | 2026 |
| California | $2,293.96 | 30.6% | -- | 2026 |
| Colorado | $4,611.46 | 61.5% | Required | 2026 |
| Connecticut | $4,047.21 | 54% | Required | 2013 |
| Delaware | $6,233.46 | 83.1% | -- | 2026 |
| Florida | $3,226.51 | 43% | -- | 2026 |
| Hawaii | $5,083.14 | 67.8% | -- | 2025 |
| Iowa | $3,806.64 | 50.8% | -- | 2024 |
| Idaho | $7,180.94 | 95.8% | Required | 2026 |
| Illinois | $6,059.11 | 80.8% | -- | 2026 |
| Indiana | $7,310.32 | 97.5% | -- | 2026 |
| Kansas | $5,871.97 | 78.3% | -- | 2026 |
| Kentucky | $3,921.05 | 52.3% | -- | 2026 |
| Louisiana | $3,878.42 | 51.7% | -- | 2026 |
| Massachusetts | $6,434.58 | 85.8% | -- | 2026 |
| Maryland | $5,298.44 | 70.7% | Required | 2026 |
| Maine | $7,335.68 | 97.8% | -- | 2026 |
| Michigan | $5,517.83 | 73.6% | -- | 2026 |
| Minnesota | $7,456.53 | 99.4% | Required | 2026 |
| Missouri | $4,429.97* | 59.1% | Not required | 2019 |
| Mississippi | $5,020.37* | 67% | -- | 2026 |
| Montana | $8,267.45 | 110.3% | Not required | 2026 |
| North Carolina | $4,073.75 | 54.3% | -- | 2025 |
| North Dakota | $8,026.44 | 107% | Required | 2026 |
| Nebraska | $6,302.30 | 84.1% | -- | 2026 |
| New Hampshire | $6,320.95 | 84.3% | Required | 2026 |
| New Jersey | $4,363.42 | 58.2% | Not required | 2026 |
| New Mexico | $7,004.30 | 93.4% | -- | 2025 |
| Nevada | $6,447.23 | 86% | -- | 2017 |
| New York | $3,535.00 | 47.1% | -- | 2026 |
| Ohio | $3,876.41 | 51.7% | -- | 2010 |
| Oklahoma | $5,001.07 | 66.7% | -- | 2026 |
| Pennsylvania | $1,600.00 | 21.3% | -- | 1985 |
| Texas | $3,904.83* | 52.1% | -- | 1992 |
| Utah | $5,916.59* | 78.9% | Not required | 2026 |
| Virginia | $3,313.00 | 44.2% | -- | 1984 |
| Vermont | $6,149.02 | 82% | -- | 2026 |
| Washington | $6,246.56 | 83.3% | -- | 2026 |
| Wisconsin | $4,124.19 | 55% | -- | 2008 |
| West Virginia | $4,986.77 | 66.5% | -- | 2026 |
| Wyoming | $5,280.38 | 70.4% | 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 189 codes from L5000 to L5992 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L5280?
43 state Medicaid programs publish a fee-for-service rate for L5280 (hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot), ranging from $1,600.00 in Pennsylvania to $8,267.45 in Montana, with a median of 67.8% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for L5280?
Montana publishes the highest Medicaid rate for L5280 at $8,267.45 (110.3% of the national Medicare amount). Pennsylvania publishes the lowest at $1,600.00.
Does L5280 require prior authorization under Medicaid?
8 of the 43 publishing states flag L5280 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".