The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 97154. 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
32
Median % of Medicare
--
Rate range
$1.63 - $68.64
97154 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $4.00 | -- | -- | 2026 |
| Arizona | $4.99 | -- | -- | 2024 |
| Colorado | $11.51 | -- | Required | 2026 |
| District of Columbia | $18.43* | -- | Not required | 2023 |
| Georgia | $19.14 | -- | -- | 2026 |
| Hawaii | $12.58 | -- | -- | 2025 |
| Illinois | $68.64 | -- | Required | 2026 |
| Indiana | $9.21* | -- | Required | 2026 |
| Kansas | $8.35 | -- | -- | 2019 |
| Kentucky | $12.18* | -- | -- | 2026 |
| Louisiana | $10.00 | -- | -- | 2026 |
| Maryland | $10.45 | -- | -- | 2025 |
| Michigan | $20.02 | -- | -- | 2026 |
| Minnesota | $6.72 | -- | Required | 2024 |
| Missouri | $2.05* | -- | Required | 2025 |
| Mississippi | $9.42 | -- | -- | 2025 |
| North Carolina | $4.18 | -- | -- | 2025 |
| North Dakota | $2.72 | -- | Required | 2026 |
| Nebraska | $18.28 | -- | -- | 2026 |
| New Hampshire | $6.50 | -- | Not required | 2026 |
| New Jersey | $4.80 | -- | Not required | 2026 |
| New Mexico | $21.88* | -- | -- | 2026 |
| Nevada | $7.60 | -- | -- | 2025 |
| New York | $3.31 | -- | -- | 2026 |
| Pennsylvania | $5.13 | -- | -- | 2023 |
| Rhode Island | $45.34 | -- | -- | 2026 |
| Texas | $1.63* | -- | -- | 2024 |
| Utah | $13.91* | -- | Required | 2026 |
| Virginia | $15.60 | -- | -- | 2021 |
| Vermont | $7.50 | -- | Required | 2019 |
| Washington | $24.80* | -- | -- | 2026 |
| Wyoming | $4.04* | -- | -- | 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 97154?
32 state Medicaid programs publish a fee-for-service rate for 97154 (group adaptive behavior treatment by protocol, 15 min), ranging from $1.63 in Texas to $68.64 in Illinois. The full table on this page lists every publishing state's current rate.
Which state pays the most for 97154?
Illinois publishes the highest Medicaid rate for 97154 at $68.64. Texas publishes the lowest at $1.63.
Does 97154 require prior authorization under Medicaid?
8 of the 32 publishing states flag 97154 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".