The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 42809. 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
$29/mo after the trial. Cancel anytime.
Publishing states
48
Median % of Medicare
69.3%
Rate range
$43.80 - $347.95
42809 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $347.95 | 162.3% | -- | 2026 |
| Alabama | $119.00 | 55.5% | -- | 2026 |
| Arkansas | $98.61 | 46% | -- | 2026 |
| Arizona | $212.90 | 99.3% | -- | 2022 |
| California | $148.55 | 69.3% | -- | 2026 |
| Colorado | $105.30 | 49.1% | -- | 2026 |
| Connecticut | $128.59 | 60% | -- | 2026 |
| District of Columbia | $195.60 | 91.2% | Not required | 2026 |
| Delaware | $207.82 | 96.9% | -- | 2026 |
| Florida | $90.92 | 42.4% | -- | 2026 |
| Georgia | $118.56 | 55.3% | -- | 2026 |
| Hawaii | $131.77 | 61.5% | -- | 2025 |
| Iowa | $108.45 | 50.6% | -- | 2024 |
| Idaho | $171.02 | 79.8% | Not required | 2026 |
| Illinois | $121.27 | 56.6% | -- | 2024 |
| Indiana | $189.45 | 88.4% | -- | 2025 |
| Kansas | $140.63 | 65.6% | -- | 2024 |
| Kentucky | $75.58 | 35.2% | -- | 2026 |
| Louisiana | $163.17 | 76.1% | -- | 2026 |
| Massachusetts | $158.48 | 73.9% | -- | 2025 |
| Maine | $144.31 | 67.3% | -- | 2026 |
| Michigan | $74.55 | 34.8% | -- | 2026 |
| Minnesota | $163.12 | 76.1% | -- | 2026 |
| Missouri | $154.52 | 72.1% | Not required | 2022 |
| Mississippi | $339.25 | -- | -- | 2026 |
| Montana | $279.45 | 130.3% | -- | 2026 |
| North Carolina | $121.65 | 56.7% | -- | 2025 |
| North Dakota | $234.68 | 109.4% | Not required | 2026 |
| Nebraska | $96.32 | 44.9% | -- | 2026 |
| New Hampshire | $43.80 | 20.4% | Not required | 2026 |
| New Jersey | $141.34 | 65.9% | Not required | 2026 |
| New Mexico | $291.48 | 135.9% | -- | 2025 |
| Nevada | $163.33 | 76.2% | -- | 2024 |
| New York | $186.33 | 86.9% | -- | 2026 |
| Ohio | $105.21 | 49.1% | -- | 2024 |
| Oklahoma | $184.38 | 86% | -- | 2026 |
| Oregon | $172.57* | 80.5% | -- | 2026 |
| Pennsylvania | $65.00 | 30.3% | -- | 2023 |
| Rhode Island | $62.73 | -- | -- | 2026 |
| South Carolina | $135.98 | 63.4% | -- | 2024 |
| Texas | $167.33* | 78% | -- | 2024 |
| Utah | $160.77* | 75% | Not required | 2026 |
| Virginia | $185.76* | 86.6% | -- | 2026 |
| Vermont | $177.80 | 82.9% | -- | 2026 |
| Washington | $130.90 | 61% | -- | 2026 |
| Wisconsin | $106.18 | 49.5% | -- | 2018 |
| West Virginia | $144.69 | 67.5% | -- | 2026 |
| Wyoming | $177.14 | 82.6% | -- | 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
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
- 10060 - Drainage of a skin abscess, simple
- 10061 - Drainage of a skin abscess, complicated or multiple
- 10080 - Drainage of a pilonidal cyst, simple
- 10081 - Drainage of a pilonidal cyst, complicated
- 10120 - Removal of a foreign body from tissue, simple
- 10121 - Removal of a foreign body from skin, complicated
- 10140 - Drainage of a blood or fluid collection under the skin
Frequently asked questions
How much does Medicaid pay for 42809?
48 state Medicaid programs publish a fee-for-service rate for 42809 (removal of a foreign body from the throat), ranging from $43.80 in New Hampshire to $347.95 in Alaska, with a median of 69.3% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 42809?
Alaska publishes the highest Medicaid rate for 42809 at $347.95 (162.3% of the national Medicare amount). New Hampshire publishes the lowest at $43.80.
Does 42809 require prior authorization under Medicaid?
No publishing state flags 42809 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.