The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99426. 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
23
Median % of Medicare
76.4%
Rate range
$30.90 - $91.81
99426 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arizona | $68.13 | 100.5% | -- | 2024 |
| California | $55.00 | 81.1% | -- | 2026 |
| Georgia | $51.79 | 76.4% | -- | 2026 |
| Hawaii | $49.70 | 73.3% | -- | 2025 |
| Iowa | $49.41 | 72.9% | -- | 2024 |
| Idaho | $55.31 | 81.6% | Not required | 2026 |
| Kentucky | $50.97 | 75.2% | -- | 2026 |
| Massachusetts | $45.64 | 67.3% | -- | 2026 |
| Maine | $46.59 | 68.7% | -- | 2026 |
| Michigan | $43.24 | 63.8% | -- | 2026 |
| Missouri | $91.58 | -- | Not required | 2026 |
| Montana | $86.69 | 127.9% | -- | 2026 |
| Nebraska | $69.78 | 102.9% | -- | 2026 |
| New Hampshire | $49.21 | 72.6% | Not required | 2026 |
| New Jersey | $52.64 | 77.6% | Not required | 2026 |
| New Mexico | $88.51 | 130.5% | -- | 2025 |
| Nevada | $66.57 | 98.2% | -- | 2024 |
| Oregon | $54.66* | 80.6% | -- | 2026 |
| Pennsylvania | $30.90 | 45.6% | -- | 2023 |
| Rhode Island | $91.81 | -- | -- | 2026 |
| Utah | $51.53* | 76% | Not required | 2026 |
| Vermont | $56.45 | 83.3% | -- | 2026 |
| West Virginia | $46.60 | 68.7% | -- | 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 99426?
23 state Medicaid programs publish a fee-for-service rate for 99426 (principal care management, clinical staff, first 30 min), ranging from $30.90 in Pennsylvania to $91.81 in Rhode Island, with a median of 76.4% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99426?
Rhode Island publishes the highest Medicaid rate for 99426 at $91.81. Pennsylvania publishes the lowest at $30.90.
Does 99426 require prior authorization under Medicaid?
No publishing state flags 99426 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.