Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L5859. 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
21
Median % of Medicare
79.7%
Rate range
$10,371.71 - $18,062.02
L5859 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $10,371.71 | 58.2% | -- | 2026 |
| Arkansas | $13,877.24* | 77.8% | -- | 2026 |
| Connecticut | $11,271.00 | 63.2% | Required | 2019 |
| District of Columbia | $13,950.32 | 78.2% | Required | 2026 |
| Hawaii | $13,248.06 | 74.3% | -- | 2025 |
| Iowa | $17,026.80 | 95.5% | -- | 2025 |
| Illinois | $15,671.51 | 87.9% | -- | 2026 |
| Indiana | $17,515.82 | 98.2% | -- | 2026 |
| Kansas | $14,222.73 | 79.7% | -- | 2026 |
| Kentucky | $15,420.61 | 86.5% | -- | 2026 |
| Massachusetts | $11,514.22 | 64.6% | -- | 2026 |
| Michigan | $13,220.94 | 74.1% | -- | 2026 |
| Minnesota | $17,866.14 | 100.2% | Required | 2026 |
| Montana | $18,062.02 | 101.3% | Not required | 2026 |
| New Jersey | $12,206.53 | 68.4% | Not required | 2026 |
| New Mexico | $17,609.11 | 98.7% | -- | 2025 |
| Ohio | $14,493.42 | 81.3% | -- | 2026 |
| Texas | $13,782.16* | 77.3% | -- | 2014 |
| Utah | $12,926.07* | 72.5% | Not required | 2026 |
| Vermont | $14,617.06 | 82% | -- | 2026 |
| Washington | $17,832.34 | 100% | -- | 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 189 codes from L5000 to L5992 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L5859?
21 state Medicaid programs publish a fee-for-service rate for L5859 (addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)), ranging from $10,371.71 in Alabama to $18,062.02 in Montana, with a median of 79.7% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for L5859?
Montana publishes the highest Medicaid rate for L5859 at $18,062.02 (101.3% of the national Medicare amount). Alabama publishes the lowest at $10,371.71.
Does L5859 require prior authorization under Medicaid?
3 of the 21 publishing states flag L5859 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".