The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 42975. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
41
Median % of Medicare
99.8%
Rate range
$42.06 - $801.58
42975 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $85.18 | 102% | -- | 2026 |
| Arkansas | $801.58* | 95% | -- | 2026 |
| Arizona | $99.72 | 119.4% | -- | 2025 |
| California | $96.80 | 115.9% | -- | 2026 |
| Colorado | $79.24 | 94.9% | -- | 2026 |
| Connecticut | $78.27 | 93.7% | -- | 2026 |
| District of Columbia | $73.22 | 87.7% | Required | 2026 |
| Delaware | $81.10 | 97.1% | -- | 2026 |
| Georgia | $93.67 | 112.2% | -- | 2026 |
| Hawaii | $98.96 | 118.5% | -- | 2025 |
| Iowa | $88.42 | 105.9% | -- | 2024 |
| Idaho | $67.22 | 80.5% | Required | 2026 |
| Illinois | $65.91 | 78.9% | -- | 2022 |
| Indiana | $88.60 | 106.1% | -- | 2025 |
| Kansas | $73.25 | 87.7% | -- | 2024 |
| Kentucky | $92.67 | 111% | -- | 2026 |
| Louisiana | $101.13 | 121.1% | -- | 2026 |
| Massachusetts | $71.48 | 85.6% | -- | 2025 |
| Maine | $57.09 | 68.4% | -- | 2026 |
| Michigan | $53.25 | 63.8% | -- | 2026 |
| Minnesota | $60.98 | 73% | -- | 2026 |
| Missouri | $129.90 | 155.6% | Not required | 2022 |
| Mississippi | $70.37 | 84.3% | -- | 2026 |
| Montana | $132.37 | 158.5% | -- | 2026 |
| North Carolina | $94.95 | 113.7% | -- | 2025 |
| North Dakota | $89.37 | 107% | Not required | 2026 |
| New Hampshire | $106.72 | 127.8% | Not required | 2026 |
| New Jersey | $42.06 | 50.4% | Not required | 2026 |
| New Mexico | $139.90 | 167.5% | -- | 2025 |
| Nevada | $140.42 | 168.2% | -- | 2024 |
| New York | $101.21 | 121.2% | -- | 2026 |
| Ohio | $87.14 | 104.4% | -- | 2022 |
| Oregon | $66.26* | 79.4% | -- | 2026 |
| Rhode Island | $202.76 | -- | -- | 2026 |
| South Carolina | $64.45 | 77.2% | -- | 2024 |
| Texas | $77.79* | 93.2% | -- | 2024 |
| Virginia | $72.34* | 86.6% | -- | 2026 |
| Vermont | $67.79 | 81.2% | -- | 2026 |
| Wisconsin | $236.52 | 283.3% | -- | 2022 |
| West Virginia | $60.02 | 71.9% | -- | 2026 |
| Wyoming | $83.34* | 99.8% | -- | 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 42975?
41 state Medicaid programs publish a fee-for-service rate for 42975 (sleep endoscopy under sedation for sleep apnea), ranging from $42.06 in New Jersey to $801.58 in Arkansas, with a median of 99.8% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 42975?
Arkansas publishes the highest Medicaid rate for 42975 at $801.58 (95% of the national Medicare amount). New Jersey publishes the lowest at $42.06.
Does 42975 require prior authorization under Medicaid?
2 of the 41 publishing states flag 42975 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".