The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 97152. 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
$29/mo after the trial. Cancel anytime.
Publishing states
25
Median % of Medicare
--
Rate range
$10.00 - $104.00
97152 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $12.50 | -- | -- | 2026 |
| Arizona | $23.95 | -- | -- | 2024 |
| Georgia | $19.86 | -- | -- | 2026 |
| Hawaii | $20.24 | -- | -- | 2025 |
| Illinois | $104.00 | -- | Required | 2026 |
| Indiana | $16.04* | -- | Required | 2026 |
| Kansas | $31.25 | -- | -- | 2019 |
| Kentucky | $12.18* | -- | -- | 2026 |
| Louisiana | $10.00 | -- | -- | 2026 |
| Maryland | $19.17 | -- | -- | 2025 |
| Michigan | $54.28 | -- | -- | 2026 |
| Missouri | $91.58 | -- | Varies | 2026 |
| Mississippi | $41.74 | -- | -- | 2019 |
| North Carolina | $18.67 | -- | -- | 2025 |
| North Dakota | $23.51 | -- | Required | 2026 |
| Nebraska | $18.28 | -- | -- | 2026 |
| New Jersey | $11.20 | -- | Not required | 2026 |
| New Mexico | $58.33* | -- | -- | 2026 |
| Nevada | $35.09 | -- | -- | 2025 |
| New York | $19.26 | -- | -- | 2026 |
| Pennsylvania | $12.73 | -- | -- | 2023 |
| Rhode Island | $45.34 | -- | -- | 2026 |
| Virginia | $23.48 | -- | -- | 2021 |
| Vermont | $30.00 | -- | -- | 2019 |
| Wyoming | $12.30* | -- | -- | 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 97152?
25 state Medicaid programs publish a fee-for-service rate for 97152 (behavior identification assessment by technician, 15 min), ranging from $10.00 in Louisiana to $104.00 in Illinois. The full table on this page lists every publishing state's current rate.
Which state pays the most for 97152?
Illinois publishes the highest Medicaid rate for 97152 at $104.00. Louisiana publishes the lowest at $10.00.
Does 97152 require prior authorization under Medicaid?
3 of the 25 publishing states flag 97152 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".