Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for G0397. 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
18
Median % of Medicare
80.6%
Rate range
$40.53 - $160.00
G0397 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| California | $60.61 | 89.8% | -- | 2026 |
| Hawaii | $64.26 | 95.2% | -- | 2025 |
| Iowa | $57.26 | 84.9% | -- | 2024 |
| Illinois | $42.66 | 63.2% | -- | 2024 |
| Indiana | $61.98 | 91.9% | -- | 2025 |
| Louisiana | $59.87 | 88.7% | -- | 2026 |
| Maine | $46.95 | 69.6% | -- | 2026 |
| Michigan | $43.03 | 63.8% | -- | 2026 |
| Minnesota | $50.94 | 75.5% | -- | 2026 |
| Missouri | $160.00 | -- | Not required | 2026 |
| Mississippi | $57.46 | 85.2% | -- | 2026 |
| Montana | $88.00 | 130.4% | -- | 2026 |
| New Jersey | $48.78 | 72.3% | Not required | 2026 |
| New Mexico | $40.53 | -- | -- | 2026 |
| Ohio | $50.06 | 74.2% | -- | 2024 |
| Oregon | $54.35* | 80.6% | -- | 2026 |
| Utah | $42.06* | -- | Not required | 2016 |
| West Virginia | $47.09 | 69.8% | -- | 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 G0397?
18 state Medicaid programs publish a fee-for-service rate for G0397 (alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes), ranging from $40.53 in New Mexico to $160.00 in Missouri, with a median of 80.6% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for G0397?
Missouri publishes the highest Medicaid rate for G0397 at $160.00. New Mexico publishes the lowest at $40.53.
Does G0397 require prior authorization under Medicaid?
No publishing state flags G0397 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.