The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 54401. 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
23
Median % of Medicare
86.6%
Rate range
$393.84 - $16,973.92
54401 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $16,973.92* | 95% | -- | 2026 |
| Colorado | $707.10 | 114.5% | -- | 2026 |
| Connecticut | $415.72 | 67.3% | Required | 2026 |
| District of Columbia | $546.01 | 88.4% | Required | 2026 |
| Hawaii | $688.69 | 111.5% | -- | 2025 |
| Illinois | $440.77 | 71.4% | -- | 2024 |
| Kentucky | $657.84 | 106.5% | Required | 2026 |
| Massachusetts | $494.62 | 80.1% | -- | 2025 |
| Maine | $421.61 | 68.3% | -- | 2026 |
| Michigan | $393.84 | 63.8% | -- | 2026 |
| Minnesota | $457.22 | 74% | Required | 2026 |
| North Dakota | $665.00 | 107.7% | Not required | 2026 |
| New Jersey | $540.70 | 87.6% | Not required | 2026 |
| Nevada | $783.59 | 126.9% | -- | 2024 |
| New York | $590.88 | 95.7% | -- | 2026 |
| Ohio | $458.75 | 74.3% | -- | 2024 |
| Oklahoma | $546.72 | 88.5% | -- | 2026 |
| Oregon | $492.24* | 79.7% | -- | 2026 |
| Rhode Island | $14,847.59 | -- | -- | 2026 |
| South Carolina | $443.05 | 71.7% | -- | 2024 |
| Virginia | $535.01* | 86.6% | -- | 2026 |
| Vermont | $504.81 | 81.7% | -- | 2026 |
| West Virginia | $437.49 | 70.8% | -- | 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 54401?
23 state Medicaid programs publish a fee-for-service rate for 54401 (penile implant insertion, inflatable, self-contained), ranging from $393.84 in Michigan to $16,973.92 in Arkansas, with a median of 86.6% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 54401?
Arkansas publishes the highest Medicaid rate for 54401 at $16,973.92 (95% of the national Medicare amount). Michigan publishes the lowest at $393.84.
Does 54401 require prior authorization under Medicaid?
4 of the 23 publishing states flag 54401 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".