The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 00104. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export
- Full state Medicaid dental network lists
- Email alerts when a state changes its rates
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Publishing states
12
Median % of Medicare
--
Rate range
$4.00 - $90.80
00104 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $32.12 | -- | -- | 2025 |
| California | $50.58 | -- | -- | 2026 |
| Colorado | $21.45 | -- | -- | 2026 |
| Delaware | $20.51 | -- | -- | 2026 |
| Hawaii | $22.80 | -- | -- | 2025 |
| Illinois | $43.20 | -- | -- | 2015 |
| Missouri | $51.92* | -- | Not required | 2025 |
| Montana | $4.00 | -- | -- | 2026 |
| Oklahoma | $37.75 | -- | -- | 2026 |
| South Carolina | $18.32* | -- | -- | 2026 |
| Vermont | $72.60 | -- | -- | 2002 |
| West Virginia | $90.80 | -- | -- | 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 anesthesia codes
- 00100 - Anesthesia for salivary gland surgery
- 00102 - Anesthesia for cleft lip repair
- 00103 - Anesthesia for eyelid surgery (blepharoplasty)
- 00120 - Anesthesia for ear surgery, other
- 00124 - Anesthesia for ear exam (otoscopy)
- 00126 - Anesthesia for eardrum surgery (tympanotomy)
- 00140 - Anesthesia for eye surgery, other
- 00142 - Anesthesia for lens (cataract) surgery
Frequently asked questions
How much does Medicaid pay for 00104?
12 state Medicaid programs publish a fee-for-service rate for 00104 (anesthesia for electroconvulsive therapy), ranging from $4.00 in Montana to $90.80 in West Virginia. The full table on this page lists every publishing state's current rate.
Which state pays the most for 00104?
West Virginia publishes the highest Medicaid rate for 00104 at $90.80. Montana publishes the lowest at $4.00.
Does 00104 require prior authorization under Medicaid?
No publishing state flags 00104 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.