G0455 Medicaid Rate by State

Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen

17 state Medicaid programs publish a fee-for-service rate for G0455 (preparation with instillation of fecal microbiota by any method, including assessment of donor specimen), ranging from $59.79 in Pennsylvania to $178.73 in Montana, with a median of 68.8% of the national Medicare amount.

Every state, kept current

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This page shows one representative rate per state for G0455. Full schedules include every locality, modifier, and age-band variant.

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Publishing states

17

Median % of Medicare

68.8%

Rate range

$59.79 - $178.73

G0455 rates in every publishing state

StateMedicaid rate% of MedicarePrior authVintage
Arizona$134.5992%--2025
District of Columbia$133.2991.1%Not required2026
Hawaii$70.3548.1%--2025
Iowa$100.6968.8%--2024
Kentucky$94.2764.4%--2026
Michigan$93.2963.8%--2026
Minnesota$112.1876.7%--2026
Montana$178.73122.2%--2026
North Carolina$88.1760.3%--2025
North Dakota$161.46110.4%Not required2026
New Mexico$131.69----2026
Oregon$118.14*80.8%--2026
Pennsylvania$59.7940.9%--2018
Rhode Island$67.57----2026
Vermont$122.0083.4%--2026
Washington$89.6361.3%--2026
West Virginia$98.3367.2%--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

All 136 codes from G0008 to G0659 or every physician code by number.

Frequently asked questions

How much does Medicaid pay for G0455?

17 state Medicaid programs publish a fee-for-service rate for G0455 (preparation with instillation of fecal microbiota by any method, including assessment of donor specimen), ranging from $59.79 in Pennsylvania to $178.73 in Montana, with a median of 68.8% of the national Medicare amount. The full table on this page lists every publishing state's current rate.

Which state pays the most for G0455?

Montana publishes the highest Medicaid rate for G0455 at $178.73 (122.2% of the national Medicare amount). Pennsylvania publishes the lowest at $59.79.

Does G0455 require prior authorization under Medicaid?

No publishing state flags G0455 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.