State prevailing rates

Please note that the CHAMPUS Maximum Allowable Charges (CMAC) take precedence over the state prevailing rates listed below.

Latest update: 08-01-2018
CPT code State Provider class Modifier Current pricing Effective date Past pricing Past effective date
0359T MS 01 00 $500.00 02/16/16
0359T MS 04 00 $500.00 02/16/16
0360T MS 04 00 $62.50 02/16/16
0360T MS 01 00 $62.50 02/16/16
0361T MS 04 00 $62.50 02/16/16
0361T MS 01 00 $62.50 02/16/16
0365T MS 01 00 $62.50 02/16/16
0365T MS 04 00 $62.50 02/16/16
0368T MS 04 00 $62.50 02/16/16
0368T MS 01 00 $62.50 02/16/16
0369T MS 01 00 $62.50 02/16/16
0369T MS 04 00 $62.50 02/16/16
0370T MS 01 00 $125.00 02/16/16
0370T MS 04 00 $125.00 02/16/16
80300 MS 01 00 $61.00 02/16/16
80300 MS 04 00 $61.00 02/16/16
80338 MS 04 91 $58.00 02/16/16
80338 MS 01 91 $58.00 02/16/16
80361 MS 04 91 $45.00 02/16/16
80361 MS 01 91 $45.00 02/16/16
80365 MS 01 00 $45.00 02/16/16
80365 MS 04 00 $45.00 02/16/16
80366 MS 01 00 $33.00 02/16/16
80366 MS 04 00 $33.00 02/16/16
80367 MS 01 00 $45.00 02/16/16
80367 MS 04 00 $45.00 02/16/16
80369 MS 01 00 $41.00 02/16/16
80369 MS 04 00 $41.00 02/16/16
80371 MS 01 00 $45.00 02/16/16
80371 MS 04 00 $45.00 02/16/16
90736 MS 04 00 $254.35 07/20/17
90736 MS 01 00 $254.35 07/20/17
99071 MS 04 00 $10.00 02/16/16
99071 MS 01 00 $10.00 02/16/16
A0431 MS 04 00 $1,305.01 04/09/18 $1,535.31 12/08/16
A0431 MS 04 00 $1,806.25 12/11/15
A0431 MS 01 00 $1,806.25 12/11/15
A0431 MS 01 00 $1,305.01 04/09/18 $1,535.31 12/08/16
A0436 MS 04 00 $20.23 12/11/15
A0436 MS 01 00 $14.62 04/09/18 $17.20 12/08/16
A0436 MS 01 00 $20.23 12/11/15
A0436 MS 04 00 $14.62 04/09/18 $17.20 12/08/16
A4554 MS 01 00 $1.93 02/16/16
A4554 MS 04 00 $1.93 02/16/16
A9150 MS 04 00 $7.00 02/16/16
A9150 MS 01 00 $7.00 02/16/16
A9270 MS 04 00 $37.54 02/16/16
A9270 MS 01 00 $37.54 02/16/16
A9300 MS 04 00 $8.50 02/16/16
A9300 MS 01 00 $8.50 02/16/16
G0477 MS 04 QW $26.00 02/29/16
G0477 MS 01 QW $26.00 02/29/16
G8428 MS 04 00 $0.01 02/16/16
G9051 MS 01 00 $27.00 02/16/16
G9051 MS 04 00 $27.00 02/16/16
G9056 MS 04 00 $27.00 02/16/16
G9056 MS 01 00 $27.00 02/16/16
H0015 MS 04 00 $291.00 02/24/16
H0015 MS 04 00 $307.00 09/18/17 $291.00 02/24/16
H0015 MS 01 00 $291.00 02/24/16
H0015 MS 01 00 $307.00 09/18/17 $291.00 02/24/16
H0035 MS 04 00 $291.00 09/22/15 $276.00 01/03/14
H0035 MS 04 00 $307.00 09/18/17 $291.00 09/22/15
H0035 MS 01 00 $307.00 09/18/17 $291.00 09/22/15
H0035 MS 01 00 $291.00 09/22/15 $276.00 01/03/14
H0037 MS 01 00 $388.00 09/22/15 $368.00 01/03/14
H0037 MS 01 00 $409.00 09/18/17 $388.00 09/22/15
H0037 MS 04 00 $388.00 09/22/15 $368.00 01/03/14
H0037 MS 04 00 $409.00 09/18/17 $388.00 09/22/15
H2017 MS 04 00 $41.60 02/16/16
H2017 MS 01 00 $41.60 02/16/16
K0739 MS 01 00 $14.87 12/01/15 $14.55 12/19/13
K0739 MS 04 00 $14.87 12/01/15 $14.55 12/19/13
K0739 MS 01 00 $15.26 01/24/18 $15.02 12/29/16
K0739 MS 04 00 $15.26 01/24/18 $15.02 12/29/16
L3215 MS 01 00 $76.60 02/16/16
L3215 MS 04 00 $76.60 02/16/16
L3219 MS 04 00 $88.20 02/16/16
L3219 MS 01 00 $88.20 02/16/16
L3222 MS 04 00 $59.00 02/16/16
L3222 MS 01 00 $59.00 02/16/16
L3230 MS 04 00 $350.00 02/16/16
L3230 MS 01 00 $350.00 02/16/16
L3250 MS 01 00 $350.00 02/16/16
L3250 MS 04 00 $350.00 02/16/16
L3251 MS 04 00 $26.30 02/16/16
L3251 MS 01 00 $26.30 02/16/16
L3252 MS 04 00 $90.00 02/16/16
L3252 MS 01 00 $90.00 02/16/16
L3253 MS 01 00 $90.00 02/16/16
L3253 MS 04 00 $90.00 02/16/16
L3265 MS 04 00 $33.00 02/16/16
L3265 MS 01 00 $33.00 02/16/16
L4205 MS 01 00 $22.16 12/01/15 $21.68 12/19/13
L4205 MS 04 00 $22.74 01/24/18 $22.38 12/29/16
L4205 MS 04 00 $22.16 12/01/15 $21.68 12/19/13
L4205 MS 01 00 $22.74 01/24/18 $22.38 12/29/16
L7520 MS 01 00 $30.08 12/01/15 $29.43 12/19/13
L7520 MS 04 00 $30.87 01/24/18 $30.38 12/29/16
L7520 MS 01 00 $30.87 01/24/18 $30.38 12/29/16
L7520 MS 04 00 $30.08 12/01/15 $29.43 12/19/13
S0017 MS 01 00 $8.53 02/16/16
S0017 MS 04 00 $8.53 02/16/16
S0020 MS 04 00 $25.00 02/16/16
S0020 MS 01 00 $25.00 02/16/16
S0023 MS 04 00 $27.43 02/16/16
S0023 MS 01 00 $27.43 02/16/16
S0028 MS 04 00 $24.00 02/16/16
S0028 MS 01 00 $24.00 02/16/16
S0030 MS 04 00 $11.28 02/16/16
S0030 MS 01 00 $35.18 02/16/16
S0032 MS 04 00 $6.60 02/16/16
S0032 MS 01 00 $6.60 02/16/16
S0073 MS 01 00 $9.41 02/16/16
S0073 MS 04 00 $9.41 02/16/16
S0074 MS 01 00 $6.33 02/16/16
S0074 MS 04 00 $6.33 02/16/16
S0077 MS 01 00 $20.00 02/16/16
S0077 MS 04 00 $20.00 02/16/16
S0078 MS 01 00 $150.79 02/16/16
S0078 MS 04 00 $150.79 02/16/16
S0080 MS 01 00 $98.75 02/16/16
S0080 MS 04 00 $98.75 02/16/16
S0081 MS 04 00 $3.53 02/16/16
S0081 MS 01 00 $3.53 02/16/16
S0395 MS 01 00 $80.00 02/16/16
S0395 MS 04 00 $80.00 02/16/16
S0621 MS 01 00 $100.00 02/16/16
S0621 MS 04 00 $75.00 02/16/16
S2900 MS 04 00 $500.00 02/16/16
S2900 MS 01 00 $500.00 02/16/16
S8186 MS 04 00 $33.50 02/16/16
S8186 MS 01 00 $33.50 02/16/16
S8451 MS 04 00 $45.00 02/16/16
S8451 MS 01 00 $45.00 02/16/16
S9083 MS 01 00 $128.00 02/16/16
S9088 MS 01 00 $75.00 02/16/16
S9470 MS 01 00 $150.00 02/16/16
S9470 MS 04 00 $150.00 02/16/16
S9480 MS 04 00 $291.00 02/24/16
S9480 MS 01 00 $291.00 02/24/16
S9480 MS 01 00 $307.00 09/18/17 $291.00 02/24/16
S9480 MS 04 00 $307.00 09/18/17 $291.00 02/24/16
S9500 MS 01 00 $230.00 02/16/16
S9502 MS 01 00 $325.00 02/16/16
S9502 MS 04 00 $325.00 02/16/16
T1017 MS 01 00 $154.91 02/16/16
T1017 MS 04 00 $14.88 02/16/16 $154.91 07/28/14
T2003 MS 01 00 $84.00 02/16/16
T2003 MS 04 00 $84.00 02/16/16
T2015 MS 04 00 $880.00 02/16/16
T2015 MS 01 00 $880.00 02/16/16
V2025 MS 01 00 $70.00 02/16/16
V2025 MS 04 00 $70.00 02/16/16
V2788 MS 01 00 $918.00 02/16/16
V2788 MS 04 00 $918.00 02/16/16