Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L6628. 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
76.7%
Rate range
$75.75 - $900.24
L6628 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $257.00 | 39.5% | -- | 2026 |
| Arkansas | $413.98* | 63.6% | -- | 2026 |
| Arizona | $546.23 | 83.9% | -- | 2026 |
| California | $280.56 | 43.1% | -- | 2026 |
| Colorado | $556.34 | 85.4% | -- | 2026 |
| Connecticut | $384.22 | 59% | Required | 2013 |
| Delaware | $671.42 | 103.1% | -- | 2026 |
| Florida | $305.31 | 46.9% | -- | 2026 |
| Hawaii | $197.62 | 30.3% | -- | 2025 |
| Iowa | $446.22 | 68.5% | -- | 2024 |
| Idaho | $611.73 | 93.9% | Not required | 2026 |
| Illinois | $532.26 | 81.7% | -- | 2026 |
| Indiana | $687.12 | 105.5% | -- | 2026 |
| Kansas | $576.09 | 88.5% | -- | 2026 |
| Kentucky | $366.44 | 56.3% | -- | 2026 |
| Louisiana | $343.07 | 52.7% | -- | 2026 |
| Massachusetts | $610.86 | 93.8% | -- | 2026 |
| Maryland | $570.71 | 87.6% | -- | 2026 |
| Maine | $696.41 | 106.9% | -- | 2026 |
| Minnesota | $700.86 | 107.6% | Conditional | 2026 |
| Missouri | $454.43* | 69.8% | Not required | 2019 |
| Mississippi | $469.18* | 72% | -- | 2026 |
| Montana | $781.97 | 120.1% | Not required | 2026 |
| North Carolina | $380.71 | 58.5% | -- | 2025 |
| North Dakota | $900.24 | 138.2% | Not required | 2026 |
| Nebraska | $618.30 | 94.9% | -- | 2026 |
| New Hampshire | $600.08 | 92.1% | Not required | 2026 |
| New Jersey | $410.54 | 63% | Not required | 2026 |
| New Mexico | $619.54 | 95.1% | -- | 2025 |
| Nevada | $454.94 | 69.9% | -- | 2017 |
| New York | $75.75 | 11.6% | -- | 2026 |
| Ohio | $364.35 | 55.9% | -- | 2010 |
| Oklahoma | $442.35 | 67.9% | -- | 2026 |
| Pennsylvania | $355.95 | 54.7% | -- | 1989 |
| South Carolina | $473.82 | 72.8% | -- | 2024 |
| Texas | $366.57* | 56.3% | -- | 1992 |
| Utah | $559.62* | 85.9% | Not required | 2026 |
| Virginia | $506.03 | 77.7% | -- | 2012 |
| Vermont | $583.75 | 89.6% | -- | 2026 |
| Washington | $532.15 | 81.7% | -- | 2026 |
| Wisconsin | $296.53 | 45.5% | -- | 2008 |
| West Virginia | $537.14 | 82.5% | -- | 2026 |
| Wyoming | $499.43 | 76.7% | -- | 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
- 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 126 codes from L6000 to L6975 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L6628?
43 state Medicaid programs publish a fee-for-service rate for L6628 (upper extremity addition, quick disconnect hook adapter, otto bock or equal), ranging from $75.75 in New York to $900.24 in North Dakota, with a median of 76.7% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for L6628?
North Dakota publishes the highest Medicaid rate for L6628 at $900.24 (138.2% of the national Medicare amount). New York publishes the lowest at $75.75.
Does L6628 require prior authorization under Medicaid?
2 of the 43 publishing states flag L6628 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".