The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 81161. 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
34
Median % of Medicare
88.9%
Rate range
$98.10 - $525.00
81161 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $279.00 | 100% | -- | 2026 |
| California | $112.90 | 40.5% | -- | 2026 |
| Connecticut | $98.10 | 35.2% | Required | 2016 |
| Delaware | $273.42 | 98% | -- | 2026 |
| Georgia | $160.00 | 57.3% | -- | 2026 |
| Hawaii | $167.40 | 60% | -- | 2025 |
| Iowa | $232.42 | 83.3% | -- | 2024 |
| Idaho | $241.06 | 86.4% | Not required | 2025 |
| Illinois | $190.03 | 68.1% | -- | 2024 |
| Indiana | $279.00 | 100% | Required | 2024 |
| Kentucky | $279.00 | 100% | -- | 2026 |
| Massachusetts | $246.04 | 88.2% | -- | 2024 |
| Maine | $98.10 | 35.2% | -- | 2026 |
| Michigan | $231.01 | 82.8% | -- | 2026 |
| Minnesota | $279.00 | 100% | -- | 2018 |
| Missouri | $251.10 | -- | Required | 2026 |
| Mississippi | $251.10 | 90% | -- | 2026 |
| Montana | $279.00 | 100% | -- | 2026 |
| North Carolina | $253.89 | 91% | -- | 2025 |
| North Dakota | $279.00 | 100% | Required | 2026 |
| New Jersey | $223.20 | 80% | Not required | 2026 |
| New Mexico | $279.00 | 100% | -- | 2024 |
| Ohio | $209.25 | 75% | -- | 2021 |
| Oklahoma | $248.17 | 88.9% | -- | 2026 |
| Oregon | $223.20* | 80% | -- | 2026 |
| Pennsylvania | $525.00 | 188.2% | -- | 2014 |
| Rhode Island | $298.01 | 106.8% | -- | 2026 |
| South Carolina | $217.62 | 78% | -- | 2026 |
| Texas | $382.23* | 137% | -- | 2021 |
| Virginia | $245.52 | 88% | -- | 2020 |
| Vermont | $272.03 | 97.5% | -- | 2026 |
| Washington | $223.20 | 80% | -- | 2026 |
| Wisconsin | $140.01 | -- | -- | 2018 |
| West Virginia | $251.10 | 90% | -- | 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 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 81161?
34 state Medicaid programs publish a fee-for-service rate for 81161 (dMD gene deletion and duplication test (muscular dystrophy)), ranging from $98.10 in Maine to $525.00 in Pennsylvania, with a median of 88.9% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 81161?
Pennsylvania publishes the highest Medicaid rate for 81161 at $525.00 (188.2% of the national Medicare amount). Maine publishes the lowest at $98.10.
Does 81161 require prior authorization under Medicaid?
4 of the 34 publishing states flag 81161 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".