The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99254. 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
30
Median % of Medicare
--
Rate range
$64.61 - $254.80
99254 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $254.80 | -- | -- | 2026 |
| Alabama | $102.00 | -- | -- | 2026 |
| Arkansas | $119.90 | -- | -- | 2026 |
| Arizona | $147.81 | -- | -- | 2022 |
| California | $65.01 | -- | -- | 2026 |
| Connecticut | $96.53 | -- | -- | 2012 |
| District of Columbia | $120.38 | -- | Not required | 2026 |
| Florida | $159.91 | -- | -- | 2025 |
| Georgia | $123.04 | -- | -- | 2026 |
| Illinois | $64.61 | -- | -- | 2026 |
| Kentucky | $107.50 | -- | -- | 2026 |
| Massachusetts | $102.94 | -- | -- | 2026 |
| Michigan | $87.76 | -- | -- | 2026 |
| Minnesota | $105.74 | -- | -- | 2026 |
| Mississippi | $130.42 | -- | -- | 2026 |
| North Carolina | $134.72 | -- | -- | 2025 |
| Nebraska | $164.52 | -- | -- | 2026 |
| New Jersey | $174.16 | -- | Not required | 2026 |
| New Mexico | $197.66 | -- | -- | 2025 |
| Nevada | $170.77 | -- | -- | 2024 |
| New York | $65.11 | -- | -- | 2026 |
| Ohio | $82.54 | -- | -- | 2024 |
| South Carolina | $101.50 | -- | -- | 2024 |
| Texas | $115.75* | -- | -- | 2007 |
| Utah | $105.63* | -- | Not required | 2026 |
| Virginia | $99.26* | -- | -- | 2026 |
| Washington | $81.79 | -- | -- | 2026 |
| Wisconsin | $94.64 | -- | -- | 2020 |
| West Virginia | $97.11 | -- | -- | 2026 |
| Wyoming | $167.12 | -- | -- | 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 99254?
30 state Medicaid programs publish a fee-for-service rate for 99254 (inpatient consultation, moderate complexity), ranging from $64.61 in Illinois to $254.80 in Alaska. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99254?
Alaska publishes the highest Medicaid rate for 99254 at $254.80. Illinois publishes the lowest at $64.61.
Does 99254 require prior authorization under Medicaid?
No publishing state flags 99254 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.