Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for G0316. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
$29/mo after the trial. Cancel anytime.
Publishing states
15
Median % of Medicare
72.5%
Rate range
$17.52 - $43.09
G0316 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| District of Columbia | $30.63 | 88.2% | Not required | 2026 |
| Hawaii | $30.61 | 88.1% | -- | 2025 |
| Iowa | $25.17 | 72.5% | -- | 2024 |
| Idaho | $28.38 | 81.7% | Not required | 2026 |
| Maine | $23.96 | 69% | -- | 2026 |
| Missouri | $23.57 | 67.8% | Not required | 2023 |
| Montana | $43.09 | 124% | -- | 2026 |
| North Dakota | $37.92 | 109.2% | Not required | 2026 |
| New Jersey | $17.52 | 50.4% | Not required | 2026 |
| New Mexico | $30.43 | 87.6% | -- | 2025 |
| Ohio | $24.25 | 69.8% | -- | 2023 |
| Oregon | $27.87* | 80.2% | -- | 2026 |
| Washington | $20.64 | 59.4% | -- | 2026 |
| Wisconsin | $23.75 | 68.4% | -- | 2023 |
| West Virginia | $24.40 | 70.2% | -- | 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
All 136 codes from G0008 to G0659 or every physician code by number.
Frequently asked questions
How much does Medicaid pay for G0316?
15 state Medicaid programs publish a fee-for-service rate for G0316 (prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)), ranging from $17.52 in New Jersey to $43.09 in Montana, with a median of 72.5% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for G0316?
Montana publishes the highest Medicaid rate for G0316 at $43.09 (124% of the national Medicare amount). New Jersey publishes the lowest at $17.52.
Does G0316 require prior authorization under Medicaid?
No publishing state flags G0316 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.