The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99242. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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- Full state Medicaid dental network lists
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Publishing states
33
Median % of Medicare
--
Rate range
$34.64 - $131.38
99242 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $131.38 | -- | -- | 2026 |
| Alabama | $64.00 | -- | -- | 2026 |
| Arkansas | $78.52 | -- | -- | 2026 |
| Arizona | $78.49 | -- | -- | 2022 |
| California | $69.09 | -- | -- | 2026 |
| Connecticut | $64.53 | -- | Required | 2012 |
| District of Columbia | $67.12 | -- | Not required | 2026 |
| Florida | $43.12 | -- | -- | 2026 |
| Georgia | $78.78 | -- | -- | 2026 |
| Illinois | $39.11 | -- | -- | 2009 |
| Kentucky | $67.83 | -- | -- | 2026 |
| Massachusetts | $57.31 | -- | -- | 2026 |
| Michigan | $35.36 | -- | -- | 2026 |
| Minnesota | $58.51 | -- | -- | 2026 |
| Mississippi | $69.43 | -- | -- | 2026 |
| North Carolina | $72.65 | -- | -- | 2025 |
| Nebraska | $93.22 | -- | -- | 2026 |
| New Jersey | $79.02 | -- | Not required | 2026 |
| New Mexico | $106.47 | -- | -- | 2023 |
| Nevada | $94.53 | -- | -- | 2024 |
| New York | $34.64 | -- | -- | 2026 |
| Ohio | $44.13 | -- | -- | 2024 |
| Pennsylvania | $43.90 | -- | -- | 2025 |
| Rhode Island | $101.35 | -- | -- | 2026 |
| South Carolina | $54.70 | -- | -- | 2024 |
| Texas | $63.37* | -- | -- | 2016 |
| Utah | $57.08* | -- | Not required | 2026 |
| Virginia | $54.21* | -- | -- | 2026 |
| Vermont | $127.25 | -- | -- | 2026 |
| Washington | $45.29 | -- | -- | 2026 |
| Wisconsin | $61.99 | -- | -- | 2020 |
| West Virginia | $51.73 | -- | -- | 2026 |
| Wyoming | $91.28 | -- | -- | 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 99242?
33 state Medicaid programs publish a fee-for-service rate for 99242 (office consultation, straightforward), ranging from $34.64 in New York to $131.38 in Alaska. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99242?
Alaska publishes the highest Medicaid rate for 99242 at $131.38. New York publishes the lowest at $34.64.
Does 99242 require prior authorization under Medicaid?
1 of the 33 publishing states flag 99242 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".