The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 90647. 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
31
Median % of Medicare
--
Rate range
$4.00 - $35.18
90647 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $25.09 | -- | -- | 2026 |
| Arizona | $31.47 | -- | -- | 2026 |
| California | $35.18 | -- | -- | 2026 |
| District of Columbia | $26.50 | -- | Not required | 2021 |
| Delaware | $15.00 | -- | -- | 2026 |
| Hawaii | $4.00 | -- | -- | 2025 |
| Iowa | $29.96 | -- | -- | 2024 |
| Idaho | $22.41 | -- | Not required | 2025 |
| Illinois | $16.26 | -- | -- | 2025 |
| Indiana | $32.26 | -- | -- | 2025 |
| Kansas | $26.12 | -- | -- | 2009 |
| Kentucky | $22.77 | -- | -- | 2026 |
| Maine | $22.16 | -- | -- | 2026 |
| Michigan | $32.56 | -- | -- | 2026 |
| Minnesota | $28.87 | -- | -- | 2022 |
| Missouri | $8.07* | -- | Not required | 2022 |
| Mississippi | $26.23 | -- | -- | 2020 |
| Montana | $31.47 | -- | -- | 2026 |
| North Carolina | $30.72 | -- | -- | 2025 |
| Nebraska | $10.92* | -- | -- | 2026 |
| New Hampshire | $30.72 | -- | Not required | 2026 |
| New Jersey | $30.41 | -- | Not required | 2026 |
| New Mexico | $24.96 | -- | -- | 2025 |
| Oklahoma | $28.77 | -- | -- | 2026 |
| Pennsylvania | $10.00 | -- | -- | 2024 |
| South Carolina | $30.85 | -- | -- | 2025 |
| Utah | $31.47* | -- | Not required | 2025 |
| Virginia | $28.05* | -- | -- | 2022 |
| Washington | $30.72 | -- | -- | 2026 |
| Wisconsin | $31.47 | -- | -- | 2026 |
| Wyoming | $22.16 | -- | -- | 2023 |
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
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
- 10060 - Drainage of a skin abscess, simple
- 10061 - Drainage of a skin abscess, complicated or multiple
- 10120 - Removal of a foreign body from tissue, simple
- 10140 - Drainage of a blood or fluid collection under the skin
- 11042 - Wound debridement, skin and tissue below, first 20 sq cm
- 11043 - Wound debridement to muscle, first 20 sq cm
- 11044 - Wound debridement to bone, first 20 sq cm
Frequently asked questions
How much does Medicaid pay for 90647?
31 state Medicaid programs publish a fee-for-service rate for 90647 (hib vaccine (PRP-OMP), 3-dose), ranging from $4.00 in Hawaii to $35.18 in California. The full table on this page lists every publishing state's current rate.
Which state pays the most for 90647?
California publishes the highest Medicaid rate for 90647 at $35.18. Hawaii publishes the lowest at $4.00.
Does 90647 require prior authorization under Medicaid?
No publishing state flags 90647 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.