The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 76497. 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
15
Median % of Medicare
--
Rate range
$38.28 - $421.01
76497 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $58.65 | -- | -- | 2021 |
| Colorado | $173.80 | -- | Required | 2026 |
| Connecticut | $38.28* | -- | -- | 2015 |
| Indiana | $53.51* | -- | -- | 2025 |
| Massachusetts | $68.50* | -- | -- | 2025 |
| Michigan | $46.50 | -- | -- | 2026 |
| Missouri | $78.45 | -- | Not required | 2026 |
| Mississippi | $66.26* | -- | -- | 2026 |
| Montana | $421.01 | -- | -- | 2026 |
| New Mexico | $59.34 | -- | -- | 2026 |
| Nevada | $112.74 | -- | -- | 2024 |
| Ohio | $140.91 | -- | -- | 2018 |
| Oklahoma | $74.25 | -- | -- | 2026 |
| Rhode Island | $154.34 | -- | -- | 2026 |
| Texas | $109.09* | -- | -- | 2025 |
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 lab & imaging codes
- 70030 - X-ray of the eye for a foreign body
- 70100 - Jaw (mandible) X-ray, up to 3 views
- 70110 - Jaw (mandible) X-ray, 4 or more views
- 70120 - X-ray of the mastoids, under 3 views per side
- 70130 - X-ray of the mastoids, complete
- 70134 - X-ray of the inner ear canals, complete
- 70140 - Facial bone X-ray, under 3 views
- 70150 - Facial bone X-ray, complete, 3 or more views
Frequently asked questions
How much does Medicaid pay for 76497?
15 state Medicaid programs publish a fee-for-service rate for 76497 (unlisted CT procedure), ranging from $38.28 in Connecticut to $421.01 in Montana. The full table on this page lists every publishing state's current rate.
Which state pays the most for 76497?
Montana publishes the highest Medicaid rate for 76497 at $421.01. Connecticut publishes the lowest at $38.28.
Does 76497 require prior authorization under Medicaid?
1 of the 15 publishing states flag 76497 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".