The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 96116. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
43
Median % of Medicare
84.2%
Rate range
$46.01 - $237.17
96116 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $175.89 | 186.7% | -- | 2026 |
| Alabama | $69.51 | 73.8% | -- | 2026 |
| Arizona | $101.80 | 108.1% | -- | 2022 |
| California | $83.60 | 88.8% | -- | 2026 |
| Colorado | $100.04 | 106.2% | -- | 2026 |
| Connecticut | $62.93 | 66.8% | -- | 2026 |
| District of Columbia | $82.50 | 87.6% | Not required | 2026 |
| Florida | $56.11 | 59.6% | -- | 2026 |
| Georgia | $90.53 | 96.1% | -- | 2026 |
| Hawaii | $79.86 | 84.8% | -- | 2025 |
| Iowa | $53.40 | 56.7% | -- | 2024 |
| Idaho | $78.39 | 83.2% | Not required | 2026 |
| Indiana | $86.93 | 92.3% | Required | 2025 |
| Kansas | $88.13 | 93.6% | -- | 2023 |
| Kentucky | $68.22 | 72.4% | -- | 2026 |
| Louisiana | $79.35 | 84.2% | -- | 2026 |
| Massachusetts | $68.84 | 73.1% | -- | 2026 |
| Maine | $65.91 | 70% | -- | 2026 |
| Michigan | $46.01 | 48.8% | -- | 2026 |
| Minnesota | $77.62 | 82.4% | Conditional | 2026 |
| Missouri | $71.12* | 75.5% | Not required | 2022 |
| Montana | $124.33 | 132% | -- | 2026 |
| North Carolina | $76.77 | 81.5% | -- | 2025 |
| North Dakota | $104.39 | 110.8% | Not required | 2026 |
| Nebraska | $149.16 | 158.4% | -- | 2026 |
| New Hampshire | $75.14 | 79.8% | Not required | 2026 |
| New Jersey | $92.29 | 98% | Not required | 2026 |
| New Mexico | $179.86 | 191% | -- | 2026 |
| Nevada | $86.33 | 91.7% | -- | 2024 |
| New York | $82.07 | 87.1% | -- | 2026 |
| Ohio | $67.31 | 71.5% | -- | 2024 |
| Oklahoma | $84.77 | 90% | -- | 2026 |
| Oregon | $76.17* | 80.9% | -- | 2026 |
| Pennsylvania | $68.72 | 73% | -- | 2025 |
| Rhode Island | $237.17 | 251.8% | -- | 2026 |
| Texas | $73.24* | 77.8% | -- | 2026 |
| Utah | $174.58* | 185.3% | Not required | 2026 |
| Virginia | $96.29 | 102.2% | -- | 2026 |
| Vermont | $78.91 | 83.8% | -- | 2026 |
| Washington | $56.18 | 59.6% | -- | 2026 |
| Wisconsin | $108.16 | 114.8% | -- | 2022 |
| West Virginia | $65.64 | 69.7% | -- | 2026 |
| Wyoming | $79.24 | 84.1% | -- | 2026 |
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 96116?
43 state Medicaid programs publish a fee-for-service rate for 96116 (neurobehavioral status exam, first hour), ranging from $46.01 in Michigan to $237.17 in Rhode Island, with a median of 84.2% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 96116?
Rhode Island publishes the highest Medicaid rate for 96116 at $237.17 (251.8% of the national Medicare amount). Michigan publishes the lowest at $46.01.
Does 96116 require prior authorization under Medicaid?
2 of the 43 publishing states flag 96116 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".