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Billing code 75957 · Radiology

75957 Medicaid reimbursement rate by state (2026)

Imaging and radiology. Medicaid pays a median of $227.74 for 75957 across 12 states, from $1.00 in Arizona to $422.54 in Arkansas.

Data as of Oct 5, 202612 statesEvery rate links to its official source

States publishing
12
National median
$227.74units vary by state
Lowest
$1.00Arizona
Highest
$422.54Arkansas
Answer

What does Medicaid pay for 75957?

12 state Medicaid programs publish a fee-for-service rate for 75957. The national median is $227.74 (units differ between states). Arkansas pays the most, $422.54, and Arizona the least, $1.00 per P, a 422.5x spread.

State ranking

75957 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 12 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Arkansas Source · since 2025-06-13$422.54——Not classified—
2New Mexico Source · since 2023-07-01$343.56——Plans must pay at least this—
3Colorado Source · since 2024-07-01$293.75——Plans negotiate; applies out of network—
6Kentucky Source · since 2020-01-01$252.50——Plans negotiate; applies out of network—
7Massachusetts Source · since 2026-10-01$202.98——Plans negotiate; applies out of network—
8Minnesota Source · since 2025-02-01$189.80——Plans negotiate; applies out of network—
11Michigan Source · since 2025-01-01$178.71——Plans negotiate; applies out of network—
12Arizona Source · since 2021-10-01$1.00P—Plans negotiate; applies out of network—
See all 12 states for 75957 — start free

4 more states, with every modifier and provider-type variant, rate history and the plan rule in each state. 14-day free trial, no credit card.

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Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices; states with several Medicare localities show a range. Confirm rates with the payer before billing.

Track 75957 in your states. Get an alert when any state changes it, with every variant and the managed-care rule.
Guide

How to read this table

  • Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 75957, so the order is by published amount and is not a like-for-like rank.
  • Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 6 of the 12 states list more than one rate for 75957, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
  • Unit. Of the 12 states, 1 publish 75957 per p, and 11 schedules print no unit at all (a flat amount per service).
  • Per hour. 75957 is not billed in time units in these states, so no hourly figure is shown.
  • Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
  • % of Medicare. No Medicare physician fee schedule amount is on file for 75957, so there is no percentage.
  • Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.
Context

Why 75957 rates differ between states

Published rates for 75957 run from $1.00 in Arizona to $422.54 in Arkansas. The two publish it in different units (no unit printed versus P), so part of that gap is the unit rather than the price. Half the states pay more than the median of $227.74 and half pay less. The usual reasons for a spread like this in radiology rates:

  • Advanced imaging such as CT, MRI and PET is often under separate pricing and prior-authorization policies that vary from state to state.
  • Some states pay hospitals for the technical component through an outpatient system and pay only the professional component from the physician schedule.
  • States that benchmark imaging to Medicare use different percentages and different Medicare years.

Timing matters too. 1 state set the current rate for 75957 in 2026 or later, while 6 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Managed care

What managed-care plans pay for 75957

No managed-care plan publishes what it pays for 75957. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 9 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet.

  • Plans negotiate; the published rate applies out of network (9 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
  • Plans must pay at least the published rate (2 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Arkansas managed care.

Billing

Units and billing for 75957

75957 is a CPT radiology code in the radiology line, billed mostly by radiology groups, imaging centers and hospitals. Imaging codes are paid per study and split into a professional component (the reading, modifier 26) and a technical component (the equipment and staff, modifier TC). A global amount covers both.

Contrast agents and radiopharmaceuticals are usually billed separately under their own codes. Imaging is billed per study, with modifier 26 for the professional component and TC for the technical component; a claim without either is paid at the global amount where the state publishes one.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.

FAQ

Frequently asked questions

What does Medicaid pay for 75957?

It depends on the state. Of the 12 states with a published fee-for-service rate, the median is $227.74. Arkansas pays the most ($422.54) and Arizona the least ($1.00 per P).

Which state pays the highest Medicaid rate for 75957?

Arkansas, at $422.54, effective 2025-06-13.

Which state pays the lowest Medicaid rate for 75957?

Arizona, at $1.00 per P, effective 2021-10-01. It publishes the code in a different unit from Arkansas, so compare per unit with care.

What unit is 75957 billed in?

Of the 12 states, 1 publish 75957 per p, and 11 schedules print no unit at all (a flat amount per service).

Do managed-care plans pay the same rate for 75957?

Not necessarily. In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 9 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.