The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 96165. 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
34
Median % of Medicare
82.6%
Rate range
$1.93 - $6.81
96165 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $5.33 | 106.4% | -- | 2025 |
| California | $4.01 | 80% | -- | 2026 |
| Connecticut | $3.37 | 67.3% | -- | 2026 |
| District of Columbia | $4.36 | 87% | Not required | 2026 |
| Delaware | $4.91 | 98% | -- | 2026 |
| Georgia | $3.97 | 79.2% | -- | 2026 |
| Hawaii | $4.09 | 81.6% | -- | 2025 |
| Iowa | $6.53 | 130.3% | -- | 2024 |
| Idaho | $4.23 | 84.4% | Not required | 2026 |
| Indiana | $4.75 | 94.8% | -- | 2026 |
| Kentucky | $3.70 | 73.9% | -- | 2026 |
| Louisiana | $4.04 | 80.6% | -- | 2026 |
| Massachusetts | $3.25 | 64.9% | -- | 2026 |
| Maine | $3.55 | 70.9% | -- | 2026 |
| Michigan | $1.93 | 38.5% | -- | 2023 |
| Minnesota | $3.85 | 76.8% | -- | 2026 |
| Missouri | $4.47* | 89.2% | Not required | 2022 |
| Montana | $6.81 | 135.9% | -- | 2026 |
| North Dakota | $5.63 | 112.4% | Not required | 2026 |
| New Hampshire | $3.02 | 60.3% | Not required | 2026 |
| New Jersey | $2.51 | 50.1% | Not required | 2026 |
| New Mexico | $6.70 | 133.7% | -- | 2025 |
| Nevada | $4.17 | 83.2% | -- | 2024 |
| Ohio | $4.15 | 82.8% | -- | 2026 |
| Oklahoma | $4.55 | 90.8% | -- | 2026 |
| Oregon | $4.08* | 81.4% | -- | 2026 |
| South Carolina | $3.17 | 63.3% | -- | 2024 |
| Texas | $3.65* | 72.9% | -- | 2020 |
| Utah | $3.87* | 77.2% | Not required | 2026 |
| Virginia | $4.34 | 86.6% | -- | 2026 |
| Vermont | $4.24 | 84.6% | -- | 2026 |
| Washington | $4.14 | 82.6% | -- | 2026 |
| Wisconsin | $4.44 | 88.6% | -- | 2022 |
| West Virginia | $3.42 | 68.3% | -- | 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
- 10004 - Needle biopsy without imaging, each added lesion
- 10005 - Needle biopsy with ultrasound guidance, first lesion
- 10006 - Needle biopsy with ultrasound guidance, each added lesion
- 10007 - Needle biopsy with fluoroscopic guidance, first lesion
- 10009 - Needle biopsy with CT guidance, first lesion
- 10011 - Needle biopsy with MRI guidance, first lesion
- 10012 - Needle biopsy with MRI guidance, each added lesion
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
Frequently asked questions
How much does Medicaid pay for 96165?
34 state Medicaid programs publish a fee-for-service rate for 96165 (health behavior intervention, group, each added 15 min), ranging from $1.93 in Michigan to $6.81 in Montana, with a median of 82.6% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 96165?
Montana publishes the highest Medicaid rate for 96165 at $6.81 (135.9% of the national Medicare amount). Michigan publishes the lowest at $1.93.
Does 96165 require prior authorization under Medicaid?
No publishing state flags 96165 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.