The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 97158. 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
27
Median % of Medicare
--
Rate range
$2.25 - $144.00
97158 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $5.00 | -- | -- | 2026 |
| Arizona | $6.93 | -- | -- | 2024 |
| Colorado | $17.83 | -- | Required | 2026 |
| Connecticut | $3.65 | -- | Required | 2026 |
| Georgia | $25.51 | -- | -- | 2026 |
| Hawaii | $24.86 | -- | -- | 2025 |
| Illinois | $144.00 | -- | Required | 2026 |
| Indiana | $11.82* | -- | Required | 2026 |
| Kansas | $8.35 | -- | -- | 2019 |
| Kentucky | $10.81* | -- | -- | 2026 |
| Louisiana | $3.00 | -- | -- | 2026 |
| Maryland | $10.45 | -- | -- | 2025 |
| Michigan | $20.02 | -- | -- | 2026 |
| Missouri | $33.77 | -- | Varies | 2026 |
| Mississippi | $12.17 | -- | -- | 2025 |
| Nebraska | $27.42 | -- | -- | 2026 |
| New Jersey | $5.60 | -- | Not required | 2026 |
| New Mexico | $15.88* | -- | -- | 2026 |
| Nevada | $14.28 | -- | -- | 2025 |
| New York | $3.31 | -- | -- | 2026 |
| Pennsylvania | $5.13 | -- | -- | 2023 |
| Rhode Island | $45.34 | -- | -- | 2026 |
| Texas | $2.25* | -- | -- | 2024 |
| Virginia | $30.54 | -- | -- | 2021 |
| Vermont | $16.45 | -- | Required | 2019 |
| Washington | $24.80* | -- | -- | 2026 |
| Wyoming | $9.31* | -- | -- | 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 97158?
27 state Medicaid programs publish a fee-for-service rate for 97158 (group adaptive behavior treatment, protocol change, 15 min), ranging from $2.25 in Texas to $144.00 in Illinois. The full table on this page lists every publishing state's current rate.
Which state pays the most for 97158?
Illinois publishes the highest Medicaid rate for 97158 at $144.00. Texas publishes the lowest at $2.25.
Does 97158 require prior authorization under Medicaid?
5 of the 27 publishing states flag 97158 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".