The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 97166. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
42
Median % of Medicare
82.9%
Rate range
$50.88 - $180.02
97166 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $180.02 | 179.1% | -- | 2026 |
| Alabama | $52.76 | 52.5% | -- | 2026 |
| Arkansas | $148.32 | 147.5% | -- | 2026 |
| Arizona | $107.04 | 106.5% | -- | 2025 |
| Colorado | $89.53 | 89.1% | -- | 2026 |
| Connecticut | $63.88 | 63.5% | -- | 2026 |
| District of Columbia | $89.62 | 89.1% | Not required | 2026 |
| Delaware | $98.17 | 97.7% | -- | 2026 |
| Hawaii | $107.85 | 107.3% | -- | 2025 |
| Iowa | $61.78 | 61.5% | -- | 2024 |
| Idaho | $83.34* | 82.9% | Not required | 2026 |
| Indiana | $96.07 | 95.6% | -- | 2026 |
| Kansas | $81.19 | 80.8% | -- | 2024 |
| Kentucky | $61.65 | 61.3% | -- | 2026 |
| Louisiana | $81.08 | 80.7% | -- | 2026 |
| Massachusetts | $76.54 | 76.1% | -- | 2026 |
| Maine | $69.87 | 69.5% | -- | 2026 |
| Michigan | $64.11 | 63.8% | -- | 2026 |
| Minnesota | $78.21 | 77.8% | Conditional | 2026 |
| Missouri | $76.29 | 75.9% | Not required | 2022 |
| Mississippi | $84.30 | 83.9% | -- | 2026 |
| Montana | $141.18 | 140.4% | Required | 2026 |
| North Carolina | $65.44 | 65.1% | -- | 2025 |
| North Dakota | $112.65 | 112.1% | Not required | 2026 |
| Nebraska | $87.74 | 87.3% | -- | 2026 |
| New Hampshire | $70.89 | 70.5% | Not required | 2026 |
| New Jersey | $50.88 | 50.6% | Not required | 2026 |
| New Mexico | $143.05 | 142.3% | -- | 2025 |
| Nevada | $68.10 | 67.7% | -- | 2025 |
| Ohio | $70.50 | 70.1% | -- | 2024 |
| Oklahoma | $89.10 | 88.6% | -- | 2026 |
| Oregon | $81.80* | 81.4% | -- | 2026 |
| Pennsylvania | $61.73* | 61.4% | -- | 2023 |
| South Carolina | $83.99* | 83.5% | -- | 2026 |
| Texas | $116.19* | 115.6% | -- | 2017 |
| Utah | $92.45* | 92% | Not required | 2026 |
| Virginia | $108.73 | 108.2% | -- | 2026 |
| Vermont | $85.00 | 84.6% | -- | 2026 |
| Washington | $61.15 | 60.8% | -- | 2026 |
| Wisconsin | $62.66 | 62.3% | -- | 2017 |
| West Virginia | $68.08 | 67.7% | -- | 2026 |
| Wyoming | $90.24 | 89.8% | -- | 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 97166?
42 state Medicaid programs publish a fee-for-service rate for 97166 (occupational therapy evaluation, moderate complexity), ranging from $50.88 in New Jersey to $180.02 in Alaska, with a median of 82.9% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 97166?
Alaska publishes the highest Medicaid rate for 97166 at $180.02 (179.1% of the national Medicare amount). New Jersey publishes the lowest at $50.88.
Does 97166 require prior authorization under Medicaid?
2 of the 42 publishing states flag 97166 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".