The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 54240. 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
33
Median % of Medicare
75%
Rate range
$48.00 - $151.47
54240 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $59.00 | 52.1% | -- | 2026 |
| Arkansas | $64.78 | 57.2% | -- | 2026 |
| Arizona | $111.57 | 98.5% | -- | 2025 |
| California | $78.93 | 69.7% | -- | 2026 |
| Colorado | $93.11 | 82.2% | -- | 2026 |
| Connecticut | $88.23 | 77.9% | -- | 2026 |
| District of Columbia | $102.12 | 90.2% | Not required | 2026 |
| Georgia | $77.65 | 68.6% | -- | 2026 |
| Hawaii | $113.72 | 100.4% | -- | 2025 |
| Iowa | $71.16 | 62.8% | -- | 2024 |
| Indiana | $98.42 | 86.9% | -- | 2026 |
| Kentucky | $67.91 | 60% | -- | 2026 |
| Massachusetts | $81.14 | 71.7% | -- | 2025 |
| Maine | $76.45 | 67.5% | -- | 2026 |
| Michigan | $72.21 | 63.8% | -- | 2026 |
| Minnesota | $84.90 | 75% | -- | 2026 |
| Missouri | $79.19 | 69.9% | Not required | 2022 |
| Mississippi | $92.36 | 81.6% | -- | 2026 |
| North Carolina | $83.44 | 73.7% | -- | 2025 |
| North Dakota | $122.79 | 108.4% | Not required | 2026 |
| Nebraska | $111.14 | 98.2% | -- | 2026 |
| New Jersey | $81.38 | 71.9% | Not required | 2026 |
| New Mexico | $151.47 | 133.8% | -- | 2025 |
| Nevada | $118.67 | 104.8% | -- | 2024 |
| New York | $95.01 | 83.9% | -- | 2026 |
| Ohio | $65.18 | 57.6% | -- | 2024 |
| Oregon | $90.65* | 80.1% | -- | 2026 |
| Pennsylvania | $48.00 | 42.4% | -- | 1988 |
| Rhode Island | $101.31 | -- | -- | 2026 |
| South Carolina | $70.67 | 62.4% | -- | 2024 |
| Virginia | $98.09* | 86.6% | -- | 2026 |
| Vermont | $93.14 | 82.3% | -- | 2026 |
| West Virginia | $78.08 | 69% | -- | 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 54240?
33 state Medicaid programs publish a fee-for-service rate for 54240 (penile blood flow measurement (plethysmography)), ranging from $48.00 in Pennsylvania to $151.47 in New Mexico, with a median of 75% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 54240?
New Mexico publishes the highest Medicaid rate for 54240 at $151.47 (133.8% of the national Medicare amount). Pennsylvania publishes the lowest at $48.00.
Does 54240 require prior authorization under Medicaid?
No publishing state flags 54240 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.