The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99245. 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
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Publishing states
34
Median % of Medicare
--
Rate range
$90.29 - $381.21
99245 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $381.21 | -- | -- | 2026 |
| Alabama | $157.00 | -- | -- | 2026 |
| Arkansas | $177.85 | -- | -- | 2026 |
| Arizona | $196.86 | -- | -- | 2022 |
| California | $190.89 | -- | -- | 2026 |
| Colorado | $193.93 | -- | Required | 2026 |
| Connecticut | $159.80 | -- | Required | 2012 |
| District of Columbia | $184.55 | -- | Not required | 2026 |
| Florida | $138.98 | -- | -- | 2026 |
| Georgia | $180.61 | -- | -- | 2026 |
| Illinois | $90.29 | -- | -- | 2009 |
| Kentucky | $166.18 | -- | -- | 2026 |
| Massachusetts | $157.82 | -- | -- | 2026 |
| Michigan | $113.96 | -- | -- | 2026 |
| Minnesota | $162.16 | -- | -- | 2026 |
| Mississippi | $196.83 | -- | -- | 2026 |
| North Carolina | $182.39 | -- | -- | 2025 |
| Nebraska | $208.39 | -- | -- | 2026 |
| New Jersey | $199.08 | -- | Not required | 2026 |
| New Mexico | $300.00 | -- | -- | 2025 |
| Nevada | $232.63 | -- | -- | 2024 |
| New York | $95.03 | -- | -- | 2026 |
| Ohio | $110.40 | -- | -- | 2024 |
| Pennsylvania | $141.97 | -- | -- | 2025 |
| Rhode Island | $237.63 | -- | -- | 2026 |
| South Carolina | $154.22 | -- | -- | 2024 |
| Texas | $152.44* | -- | -- | 2007 |
| Utah | $160.19* | -- | Not required | 2026 |
| Virginia | $151.06* | -- | -- | 2026 |
| Vermont | $350.61 | -- | -- | 2026 |
| Washington | $125.17 | -- | -- | 2026 |
| Wisconsin | $142.42 | -- | -- | 2024 |
| West Virginia | $146.16 | -- | -- | 2026 |
| Wyoming | $225.70 | -- | -- | 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 99245?
34 state Medicaid programs publish a fee-for-service rate for 99245 (office consultation, high complexity), ranging from $90.29 in Illinois to $381.21 in Alaska. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99245?
Alaska publishes the highest Medicaid rate for 99245 at $381.21. Illinois publishes the lowest at $90.29.
Does 99245 require prior authorization under Medicaid?
2 of the 34 publishing states flag 99245 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".