The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 19396. 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
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Publishing states
31
Median % of Medicare
70.2%
Rate range
$111.04 - $1,523.02
19396 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $1,523.02* | 95% | -- | 2026 |
| Arizona | $274.75 | 94.2% | -- | 2025 |
| California | $215.19 | 73.8% | -- | 2026 |
| Colorado | $145.84 | 50% | Required | 2026 |
| Connecticut | $168.85 | 57.9% | Required | 2026 |
| District of Columbia | $267.10 | 91.6% | Not required | 2026 |
| Delaware | $282.38 | 96.8% | -- | 2026 |
| Hawaii | $144.72 | 49.6% | -- | 2025 |
| Illinois | $133.18 | 45.7% | -- | 2026 |
| Kentucky | $113.32 | 38.9% | Required | 2026 |
| Louisiana | $212.11 | 72.7% | -- | 2026 |
| Massachusetts | $213.40 | 73.2% | -- | 2025 |
| Maine | $195.52 | 67.1% | -- | 2026 |
| Michigan | $185.95 | 63.8% | -- | 2026 |
| Minnesota | $222.04 | 76.2% | -- | 2026 |
| Montana | $366.05 | 125.5% | Required | 2026 |
| North Dakota | $319.17 | 109.5% | Required | 2026 |
| Nebraska | $111.14 | 38.1% | -- | 2026 |
| New Hampshire | $204.61 | 70.2% | Required | 2026 |
| New Jersey | $114.11 | 39.1% | Not required | 2026 |
| New Mexico | $379.35 | 130.1% | -- | 2025 |
| Nevada | $180.79 | 62% | -- | 2024 |
| Ohio | $133.63 | 45.8% | -- | 2017 |
| Oklahoma | $249.53 | 85.6% | -- | 2026 |
| Oregon | $234.63* | 80.5% | -- | 2026 |
| Texas | $114.14* | 39.1% | -- | 2025 |
| Vermont | $241.66 | 82.9% | Required | 2026 |
| Washington | $178.49 | 61.2% | -- | 2026 |
| Wisconsin | $111.04 | 38.1% | -- | 2008 |
| West Virginia | $196.42 | 67.4% | -- | 2026 |
| Wyoming | $231.99 | 79.6% | Required | 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 physician codes
- 10004 - Needle biopsy without imaging, each added lesion
- 10005 - Needle biopsy with ultrasound guidance, first lesion
- 10006 - Needle biopsy with ultrasound guidance, each added lesion
- 10007 - Needle biopsy with fluoroscopic guidance, first lesion
- 10009 - Needle biopsy with CT guidance, first lesion
- 10011 - Needle biopsy with MRI guidance, first lesion
- 10012 - Needle biopsy with MRI guidance, each added lesion
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
Frequently asked questions
How much does Medicaid pay for 19396?
31 state Medicaid programs publish a fee-for-service rate for 19396 (custom breast implant mold preparation), ranging from $111.04 in Wisconsin to $1,523.02 in Arkansas, with a median of 70.2% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 19396?
Arkansas publishes the highest Medicaid rate for 19396 at $1,523.02 (95% of the national Medicare amount). Wisconsin publishes the lowest at $111.04.
Does 19396 require prior authorization under Medicaid?
8 of the 31 publishing states flag 19396 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".