The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 81323. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
35
Median % of Medicare
86.4%
Rate range
$52.56 - $411.00
81323 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $300.00 | 100% | -- | 2026 |
| Arkansas | $70.61 | 23.5% | -- | 2026 |
| Arizona | $300.00 | 100% | -- | 2026 |
| California | $69.90 | 23.3% | -- | 2026 |
| Connecticut | $61.32 | 20.4% | Required | 2015 |
| Georgia | $69.90 | 23.3% | -- | 2026 |
| Hawaii | $52.56 | 17.5% | -- | 2025 |
| Iowa | $249.90 | 83.3% | -- | 2024 |
| Idaho | $259.20 | 86.4% | Required | 2025 |
| Illinois | $204.33 | 68.1% | -- | 2024 |
| Indiana | $300.00 | 100% | Required | 2024 |
| Kansas | $74.46 | 24.8% | -- | 2014 |
| Kentucky | $300.00 | 100% | -- | 2026 |
| Massachusetts | $264.56 | 88.2% | -- | 2024 |
| Maine | $61.32 | 20.4% | -- | 2026 |
| Michigan | $248.40 | 82.8% | -- | 2026 |
| Minnesota | $300.00 | 100% | -- | 2018 |
| Missouri | $270.00 | -- | Required | 2026 |
| Mississippi | $270.00 | 90% | -- | 2026 |
| Montana | $300.00 | 100% | -- | 2026 |
| North Dakota | $300.00 | 100% | Required | 2026 |
| New Hampshire | $259.50 | 86.5% | Not required | 2026 |
| New Jersey | $240.00 | 80% | Not required | 2026 |
| New Mexico | $300.00 | 100% | -- | 2025 |
| Ohio | $225.00 | 75% | -- | 2019 |
| Oklahoma | $266.85 | 89% | -- | 2026 |
| Oregon | $240.00* | 80% | -- | 2026 |
| South Carolina | $234.00 | 78% | -- | 2026 |
| Texas | $411.00* | 137% | -- | 2021 |
| Virginia | $73.79 | 24.6% | -- | 2014 |
| Vermont | $292.50 | 97.5% | -- | 2026 |
| Washington | $240.00 | 80% | -- | 2026 |
| Wisconsin | $70.08 | 23.4% | -- | 2013 |
| West Virginia | $270.00 | 90% | -- | 2026 |
| Wyoming | $270.00 | 90% | Required | 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 81323?
35 state Medicaid programs publish a fee-for-service rate for 81323 (pTEN gene deletion and duplication test), ranging from $52.56 in Hawaii to $411.00 in Texas, with a median of 86.4% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 81323?
Texas publishes the highest Medicaid rate for 81323 at $411.00 (137% of the national Medicare amount). Hawaii publishes the lowest at $52.56.
Does 81323 require prior authorization under Medicaid?
6 of the 35 publishing states flag 81323 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".