The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 97156. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
33
Median % of Medicare
--
Rate range
$5.25 - $326.24
97156 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $30.00 | -- | -- | 2026 |
| Arkansas | $20.00* | -- | -- | 2026 |
| Arizona | $19.02 | -- | -- | 2021 |
| Connecticut | $28.00 | -- | Required | 2025 |
| Delaware | $31.25 | -- | -- | 2026 |
| Georgia | $20.63 | -- | -- | 2026 |
| Hawaii | $46.20 | -- | -- | 2025 |
| Illinois | $326.24* | -- | Required | 2026 |
| Indiana | $21.87* | -- | Required | 2024 |
| Kansas | $37.50 | -- | -- | 2019 |
| Kentucky | $21.35* | -- | -- | 2026 |
| Louisiana | $5.25 | -- | -- | 2026 |
| Michigan | $38.28 | -- | -- | 2026 |
| Minnesota | $20.17 | -- | Required | 2024 |
| Missouri | $33.77 | -- | Varies | 2026 |
| Mississippi | $28.45 | -- | -- | 2026 |
| North Carolina | $17.55 | -- | -- | 2025 |
| North Dakota | $29.48 | -- | Required | 2026 |
| Nebraska | $27.42 | -- | -- | 2026 |
| New Hampshire | $16.43 | -- | Required | 2026 |
| New Jersey | $25.00 | -- | Not required | 2026 |
| New Mexico | $25.78* | -- | -- | 2026 |
| Nevada | $21.32 | -- | -- | 2025 |
| New York | $19.26 | -- | -- | 2026 |
| Oklahoma | $23.55 | -- | -- | 2026 |
| Pennsylvania | $22.09 | -- | -- | 2023 |
| Rhode Island | $45.34 | -- | -- | 2026 |
| Texas | $18.40* | -- | -- | 2025 |
| Utah | $37.51* | -- | Required | 2026 |
| Virginia | $46.63 | -- | -- | 2021 |
| Vermont | $21.39 | -- | Required | 2019 |
| Washington | $18.32 | -- | -- | 2026 |
| Wyoming | $24.60* | -- | -- | 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 97156?
33 state Medicaid programs publish a fee-for-service rate for 97156 (family adaptive behavior treatment guidance (ABA), each 15 minutes), ranging from $5.25 in Louisiana to $326.24 in Illinois. The full table on this page lists every publishing state's current rate.
Which state pays the most for 97156?
Illinois publishes the highest Medicaid rate for 97156 at $326.24. Louisiana publishes the lowest at $5.25.
Does 97156 require prior authorization under Medicaid?
8 of the 33 publishing states flag 97156 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".