Every state, kept current
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 and state 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
All 68 codes from 97010 to 97814 or every physician code by number.
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".