Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for G0538. 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
12
Median % of Medicare
77%
Rate range
$7.81 - $98.81
G0538 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Colorado | $12.35 | 72.5% | -- | 2026 |
| District of Columbia | $15.44 | 90.7% | Not required | 2026 |
| Minnesota | $13.12 | 77% | -- | 2026 |
| Montana | $21.34 | 125.3% | -- | 2026 |
| New Jersey | $7.81 | 45.9% | Not required | 2026 |
| New Mexico | $14.43 | 84.7% | -- | 2025 |
| Ohio | $11.45 | 67.2% | -- | 2025 |
| Oregon | $13.80* | 81% | -- | 2026 |
| Rhode Island | $98.81 | -- | -- | 2026 |
| Vermont | $14.29 | 83.9% | -- | 2026 |
| Wisconsin | $11.61 | 68.2% | -- | 2025 |
| West Virginia | $11.47 | 67.4% | -- | 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 G0538?
12 state Medicaid programs publish a fee-for-service rate for G0538 (atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month), ranging from $7.81 in New Jersey to $98.81 in Rhode Island, with a median of 77% of the national Medicare amount. The full table on this page lists every publishing state's current rate.
Which state pays the most for G0538?
Rhode Island publishes the highest Medicaid rate for G0538 at $98.81. New Jersey publishes the lowest at $7.81.
Does G0538 require prior authorization under Medicaid?
No publishing state flags G0538 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.