The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 90677. 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
35
Median % of Medicare
--
Rate range
$8.07 - $341.00
90677 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $312.90 | -- | -- | 2026 |
| Arkansas | $283.71 | -- | -- | 2026 |
| Arizona | $341.00 | -- | -- | 2026 |
| California | $317.36 | -- | -- | 2026 |
| Connecticut | $312.90 | -- | -- | 2026 |
| District of Columbia | $312.90 | -- | Not required | 2026 |
| Delaware | $15.00 | -- | -- | 2026 |
| Florida | $261.56* | -- | -- | 2025 |
| Iowa | $257.09 | -- | -- | 2024 |
| Idaho | $270.35 | -- | Not required | 2026 |
| Illinois | $16.26 | -- | -- | 2025 |
| Indiana | $313.42 | -- | -- | 2026 |
| Kansas | $341.00 | -- | -- | 2026 |
| Kentucky | $283.72 | -- | -- | 2026 |
| Michigan | $341.00 | -- | -- | 2026 |
| Minnesota | $341.00 | -- | -- | 2026 |
| Missouri | $8.07* | -- | Not required | 2023 |
| Mississippi | $283.72 | -- | -- | 2023 |
| Montana | $312.90 | -- | -- | 2026 |
| North Carolina | $317.12 | -- | -- | 2026 |
| North Dakota | $341.00 | -- | Not required | 2026 |
| Nebraska | $341.00 | -- | -- | 2026 |
| New Hampshire | $298.50 | -- | Not required | 2026 |
| New Jersey | $300.16 | -- | Not required | 2026 |
| New Mexico | $298.04 | -- | -- | 2025 |
| Oklahoma | $319.28 | -- | -- | 2026 |
| Pennsylvania | $10.00 | -- | -- | 2023 |
| South Carolina | $294.34 | -- | -- | 2026 |
| Texas | $294.79* | -- | -- | 2026 |
| Utah | $341.00* | -- | Not required | 2026 |
| Virginia | $341.00 | -- | -- | 2026 |
| Vermont | $297.26 | -- | -- | 2026 |
| Washington | $341.00 | -- | -- | 2026 |
| Wisconsin | $247.60 | -- | -- | 2026 |
| Wyoming | $288.66 | -- | -- | 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 90677?
35 state Medicaid programs publish a fee-for-service rate for 90677 (pneumococcal conjugate vaccine, 20-valent), ranging from $8.07 in Missouri to $341.00 in Arizona. The full table on this page lists every publishing state's current rate.
Which state pays the most for 90677?
Arizona publishes the highest Medicaid rate for 90677 at $341.00. Missouri publishes the lowest at $8.07.
Does 90677 require prior authorization under Medicaid?
No publishing state flags 90677 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.