The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for V5264. Full schedules include every locality, modifier, and age-band variant.
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Publishing states
34
Median % of Medicare
--
Rate range
$18.15 - $79.05
V5264 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $50.00 | -- | -- | 2026 |
| California | $27.52 | -- | -- | 2026 |
| Colorado | $58.11 | -- | -- | 2026 |
| Connecticut | $32.00 | -- | -- | 2007 |
| Hawaii | $30.00 | -- | -- | 2025 |
| Iowa | $26.68 | -- | -- | 2024 |
| Illinois | $46.57 | -- | -- | 2026 |
| Indiana | $45.91 | -- | -- | 2025 |
| Kansas | $27.00 | -- | -- | 2002 |
| Kentucky | $40.00 | -- | -- | 2003 |
| Maine | $45.50 | -- | -- | 2026 |
| Michigan | $45.54 | -- | -- | 2026 |
| Minnesota | $48.00 | -- | -- | 2010 |
| Missouri | $25.76* | -- | Not required | 2019 |
| Mississippi | $18.15 | -- | -- | 2003 |
| Montana | $26.53 | -- | -- | 2026 |
| North Dakota | $79.05 | -- | Required | 2026 |
| Nebraska | $52.17 | -- | -- | 2026 |
| New Hampshire | $42.52 | -- | Not required | 2026 |
| New Jersey | $36.46 | -- | Required | 2026 |
| Nevada | $30.00 | -- | -- | 2006 |
| New York | $30.30 | -- | -- | 2026 |
| Ohio | $25.46 | -- | -- | 2024 |
| Oklahoma | $46.82 | -- | -- | 2020 |
| Pennsylvania | $40.00 | -- | -- | 2005 |
| South Carolina | $58.20 | -- | -- | 2017 |
| Texas | $38.82* | -- | -- | 2026 |
| Utah | $38.00* | -- | Not required | 2016 |
| Virginia | $35.00* | -- | -- | 2004 |
| Vermont | $40.00 | -- | -- | 2026 |
| Washington | $38.87* | -- | -- | 2026 |
| Wisconsin | $51.18 | -- | -- | 2022 |
| West Virginia | $34.75 | -- | -- | 2026 |
| Wyoming | $56.38 | -- | -- | 2023 |
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.
Frequently asked questions
How much does Medicaid pay for V5264?
34 state Medicaid programs publish a fee-for-service rate for V5264 (ear mold/insert, not disposable, any type), ranging from $18.15 in Mississippi to $79.05 in North Dakota. The full table on this page lists every publishing state's current rate.
Which state pays the most for V5264?
North Dakota publishes the highest Medicaid rate for V5264 at $79.05. Mississippi publishes the lowest at $18.15.
Does V5264 require prior authorization under Medicaid?
2 of the 34 publishing states flag V5264 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".