The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 81416. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
30
Median % of Medicare
90%
Rate range
$958.56 - $12,000.00
81416 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $12,000.00 | 100% | -- | 2026 |
| Arizona | $12,000.00 | 100% | -- | 2026 |
| Connecticut | $8,400.00 | 70% | Required | 2018 |
| Hawaii | $7,200.00 | 60% | -- | 2025 |
| Iowa | $10,935.88 | 91.1% | -- | 2024 |
| Idaho | $10,368.00 | 86.4% | Required | 2025 |
| Illinois | $8,173.20 | 68.1% | -- | 2024 |
| Indiana | $12,000.00 | 100% | Required | 2024 |
| Kentucky | $12,000.00 | 100% | -- | 2026 |
| Massachusetts | $10,582.50 | 88.2% | -- | 2024 |
| Maine | $8,400.00 | 70% | -- | 2026 |
| Michigan | $9,936.00 | 82.8% | -- | 2026 |
| Minnesota | $12,000.00 | 100% | Required | 2018 |
| Missouri | $10,800.00 | -- | Required | 2026 |
| Mississippi | $10,800.00 | 90% | -- | 2026 |
| Montana | $12,000.00 | 100% | Required | 2026 |
| North Carolina | $10,920.00 | 91% | -- | 2025 |
| North Dakota | $12,000.00 | 100% | Required | 2026 |
| New Jersey | $9,600.00 | 80% | Not required | 2026 |
| New Mexico | $12,000.00 | 100% | -- | 2024 |
| Ohio | $9,000.00 | 75% | -- | 2019 |
| Oregon | $9,600.00* | 80% | -- | 2026 |
| South Carolina | $9,360.00 | 78% | -- | 2026 |
| Texas | $5,500.82* | 45.8% | -- | 2026 |
| Utah | $11,964.41* | 99.7% | Required | 2026 |
| Virginia | $10,560.00 | 88% | -- | 2018 |
| Washington | $958.56 | 8% | -- | 2026 |
| Wisconsin | $9,600.00 | -- | -- | 2020 |
| West Virginia | $10,800.00 | 90% | -- | 2026 |
| Wyoming | $10,800.00 | 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 81416?
30 state Medicaid programs publish a fee-for-service rate for 81416 (whole exome sequencing, comparator (parent or sibling)), ranging from $958.56 in Washington to $12,000.00 in Arkansas, with a median of 90% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 81416?
Arkansas publishes the highest Medicaid rate for 81416 at $12,000.00 (100% of the national Medicare amount). Washington publishes the lowest at $958.56.
Does 81416 require prior authorization under Medicaid?
9 of the 30 publishing states flag 81416 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".