The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 90697. 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
24
Median % of Medicare
--
Rate range
$0.01 - $167.75
90697 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $15.45* | -- | -- | 2026 |
| Arizona | $167.36 | -- | -- | 2026 |
| California | $167.32 | -- | -- | 2026 |
| Delaware | $15.00 | -- | -- | 2026 |
| Iowa | $147.71 | -- | -- | 2023 |
| Idaho | $88.40 | -- | Not required | 2025 |
| Illinois | $16.26 | -- | -- | 2025 |
| Kansas | $0.01 | -- | -- | 2021 |
| Kentucky | $132.77 | -- | -- | 2026 |
| Minnesota | $167.36 | -- | -- | 2026 |
| Missouri | $32.20* | -- | Not required | 2021 |
| Montana | $156.70 | -- | -- | 2026 |
| North Carolina | $167.75 | -- | -- | 2026 |
| Nebraska | $10.92* | -- | -- | 2026 |
| New Hampshire | $162.86 | -- | Not required | 2026 |
| New Jersey | $161.23 | -- | Not required | 2026 |
| Oklahoma | $165.13 | -- | -- | 2026 |
| Pennsylvania | $10.00 | -- | -- | 2023 |
| South Carolina | $163.94 | -- | -- | 2026 |
| Utah | $167.36* | -- | Not required | 2026 |
| Virginia | $132.76* | -- | -- | 2021 |
| Washington | $162.86 | -- | -- | 2026 |
| Wisconsin | $156.70 | -- | -- | 2026 |
| Wyoming | $139.82* | -- | -- | 2022 |
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
- 10080 - Drainage of a pilonidal cyst, simple
- 10081 - Drainage of a pilonidal cyst, complicated
- 10120 - Removal of a foreign body from tissue, simple
- 10121 - Removal of a foreign body from skin, complicated
- 10140 - Drainage of a blood or fluid collection under the skin
Frequently asked questions
How much does Medicaid pay for 90697?
24 state Medicaid programs publish a fee-for-service rate for 90697 (six-in-one pediatric vaccine (DTaP-IPV-Hib-HepB)), ranging from $0.01 in Kansas to $167.75 in North Carolina. The full table on this page lists every publishing state's current rate.
Which state pays the most for 90697?
North Carolina publishes the highest Medicaid rate for 90697 at $167.75. Kansas publishes the lowest at $0.01.
Does 90697 require prior authorization under Medicaid?
No publishing state flags 90697 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.