The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 97551. 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
20
Median % of Medicare
83.1%
Rate range
$10.30 - $37.80
97551 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $27.20 | 104.4% | -- | 2025 |
| District of Columbia | $22.76 | 87.4% | Not required | 2026 |
| Hawaii | $25.05 | 96.2% | -- | 2025 |
| Iowa | $23.99 | 92.1% | -- | 2025 |
| Kentucky | $22.54 | 86.5% | -- | 2026 |
| Massachusetts | $19.79 | 76% | -- | 2026 |
| Michigan | $16.61 | 63.8% | -- | 2026 |
| Minnesota | $20.06 | 77% | Conditional | 2026 |
| Missouri | $10.30 | 39.5% | Not required | 2024 |
| Montana | $35.87 | 137.7% | -- | 2026 |
| North Carolina | $21.65 | 83.1% | -- | 2025 |
| Nebraska | $20.83 | 80% | -- | 2026 |
| New Jersey | $13.07 | 50.2% | Not required | 2026 |
| New Mexico | $37.80 | 145.1% | -- | 2025 |
| Ohio | $20.14 | 77.3% | -- | 2024 |
| Oregon | $21.20* | 81.4% | -- | 2026 |
| Virginia | $22.57 | 86.6% | -- | 2026 |
| Vermont | $22.05 | 84.6% | -- | 2026 |
| Washington | $15.67 | 60.2% | -- | 2026 |
| West Virginia | $18.06 | 69.3% | -- | 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 97551?
20 state Medicaid programs publish a fee-for-service rate for 97551 (caregiver training without patient, each added 15 min), ranging from $10.30 in Missouri to $37.80 in New Mexico, with a median of 83.1% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 97551?
New Mexico publishes the highest Medicaid rate for 97551 at $37.80 (145.1% of the national Medicare amount). Missouri publishes the lowest at $10.30.
Does 97551 require prior authorization under Medicaid?
1 of the 20 publishing states flag 97551 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".