Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for Q4250. 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
12
Median % of Medicare
81.7%
Rate range
$50.55 - $2,979.56
Q4250 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $120.78* | -- | -- | 2026 |
| District of Columbia | $119.93 | 94.2% | Required | 2026 |
| Indiana | $50.55 | 39.7% | -- | 2026 |
| Kentucky | $124.11 | -- | -- | 2026 |
| Michigan | $81.15 | 63.8% | -- | 2026 |
| Missouri | $112.18 | -- | Not required | 2026 |
| Montana | $2,979.56 | 2341.5% | -- | 2026 |
| Oregon | $103.91* | 81.7% | -- | 2026 |
| South Carolina | $83.49 | 65.6% | -- | 2026 |
| Texas | $2,979.56* | 2341.5% | -- | 2026 |
| Utah | $66.23* | -- | Not required | 2026 |
| West Virginia | $80.76 | 63.5% | -- | 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 state-specific services codes
- C1716 - Brachytherapy source, non-stranded, gold-198, per source
- C1717 - Brachytherapy source, non-stranded, high dose rate iridium-192, per source
- C1719 - Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source
- C2616 - Brachytherapy source, non-stranded, yttrium-90, per source
- C2634 - Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source
- C2635 - Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source
- C2636 - Brachytherapy linear source, non-stranded, palladium-103, per 1 mm
- C2638 - Brachytherapy source, stranded, iodine-125, per source
All 325 codes from Q4001 to Q4420 or every state-specific services code by number.
Frequently asked questions
How much does Medicaid pay for Q4250?
12 state Medicaid programs publish a fee-for-service rate for Q4250 (amnioamp-mp, per square centimeter (add-on, list separately in addition to primary procedure)), ranging from $50.55 in Indiana to $2,979.56 in Montana, with a median of 81.7% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for Q4250?
Montana publishes the highest Medicaid rate for Q4250 at $2,979.56 (2341.5% of the national Medicare amount). Indiana publishes the lowest at $50.55.
Does Q4250 require prior authorization under Medicaid?
1 of the 12 publishing states flag Q4250 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".