The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99403. 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
29
Median % of Medicare
--
Rate range
$28.46 - $154.44
99403 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $154.44 | -- | -- | 2026 |
| Arizona | $78.59 | -- | -- | 2024 |
| California | $38.37 | -- | -- | 2026 |
| Colorado | $77.27 | -- | -- | 2026 |
| Connecticut | $78.95 | -- | -- | 2008 |
| District of Columbia | $78.12 | -- | Not required | 2026 |
| Delaware | $68.18 | -- | -- | 2026 |
| Florida | $48.48* | -- | -- | 2026 |
| Iowa | $35.98 | -- | -- | 2013 |
| Idaho | $94.02 | -- | Not required | 2025 |
| Indiana | $80.03 | -- | -- | 2025 |
| Kansas | $30.00 | -- | -- | 2021 |
| Kentucky | $62.34 | -- | -- | 2026 |
| Louisiana | $40.85 | -- | -- | 2026 |
| Massachusetts | $64.53 | -- | -- | 2026 |
| Maine | $84.23 | -- | -- | 2026 |
| Michigan | $56.23 | -- | -- | 2026 |
| Minnesota | $68.48 | -- | -- | 2026 |
| Montana | $116.16 | -- | -- | 2026 |
| New Hampshire | $49.05 | -- | Not required | 2026 |
| New Jersey | $53.43 | -- | Not required | 2026 |
| New Mexico | $122.38 | -- | -- | 2025 |
| Nevada | $56.02 | -- | -- | 2022 |
| Ohio | $58.70 | -- | -- | 2024 |
| South Carolina | $62.96 | -- | -- | 2024 |
| Vermont | $73.56 | -- | -- | 2026 |
| Wisconsin | $28.46 | -- | -- | 2008 |
| West Virginia | $61.00 | -- | -- | 2026 |
| Wyoming | $81.22 | -- | -- | 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 99403?
29 state Medicaid programs publish a fee-for-service rate for 99403 (preventive counseling, individual, 45 minutes), ranging from $28.46 in Wisconsin to $154.44 in Alaska. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99403?
Alaska publishes the highest Medicaid rate for 99403 at $154.44. Wisconsin publishes the lowest at $28.46.
Does 99403 require prior authorization under Medicaid?
No publishing state flags 99403 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.