The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99255. 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
30
Median % of Medicare
--
Rate range
$80.35 - $346.28
99255 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $346.28 | -- | -- | 2026 |
| Alabama | $140.00 | -- | -- | 2026 |
| Arkansas | $123.20 | -- | -- | 2026 |
| Arizona | $178.82 | -- | -- | 2022 |
| California | $86.25 | -- | -- | 2026 |
| Connecticut | $120.07 | -- | -- | 2012 |
| District of Columbia | $160.88 | -- | Not required | 2026 |
| Florida | $199.37 | -- | -- | 2025 |
| Georgia | $167.90 | -- | -- | 2026 |
| Illinois | $84.75 | -- | -- | 2026 |
| Kentucky | $148.20 | -- | -- | 2026 |
| Massachusetts | $137.48 | -- | -- | 2026 |
| Michigan | $117.79 | -- | -- | 2026 |
| Minnesota | $141.69 | -- | -- | 2026 |
| Mississippi | $176.02 | -- | -- | 2026 |
| North Carolina | $164.15 | -- | -- | 2025 |
| Nebraska | $219.36 | -- | -- | 2026 |
| New Jersey | $283.50 | -- | Not required | 2026 |
| New Mexico | $267.05 | -- | -- | 2025 |
| Nevada | $206.45 | -- | -- | 2024 |
| New York | $80.35 | -- | -- | 2026 |
| Ohio | $99.84 | -- | -- | 2024 |
| South Carolina | $136.98 | -- | -- | 2024 |
| Texas | $151.82* | -- | -- | 2007 |
| Utah | $142.11* | -- | Not required | 2026 |
| Virginia | $133.23* | -- | -- | 2026 |
| Washington | $109.31 | -- | -- | 2026 |
| Wisconsin | $105.68 | -- | -- | 2020 |
| West Virginia | $130.78 | -- | -- | 2026 |
| Wyoming | $201.98 | -- | -- | 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 99255?
30 state Medicaid programs publish a fee-for-service rate for 99255 (inpatient consultation, high complexity), ranging from $80.35 in New York to $346.28 in Alaska. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99255?
Alaska publishes the highest Medicaid rate for 99255 at $346.28. New York publishes the lowest at $80.35.
Does 99255 require prior authorization under Medicaid?
No publishing state flags 99255 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.