75958 Medicaid reimbursement rate by state (2026)
Imaging and radiology. Medicaid pays a median of $151.48 for 75958 across 12 states, from $1.00 in Arizona to $281.70 in Arkansas.
- States publishing
- 12
- National median
- $151.48units vary by state
- Lowest
- $1.00Arizona
- Highest
- $281.70Arkansas
What does Medicaid pay for 75958?
12 state Medicaid programs publish a fee-for-service rate for 75958. The national median is $151.48 (units differ between states). Arkansas pays the most, $281.70, and Arizona the least, $1.00 per P, a 281.7x spread.
75958 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.
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 75958, 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 75958, 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 75958 per p, and 11 schedules print no unit at all (a flat amount per service).
- Per hour. 75958 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 75958, 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.
Why 75958 rates differ between states
Published rates for 75958 run from $1.00 in Arizona to $281.70 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 $151.48 and half pay less. The usual reasons for a spread like this in radiology rates:
- States that benchmark imaging to Medicare use different percentages and different Medicare years.
- Imaging fees are split into a professional component (the reading) and a technical component (the equipment and staff), and states publish one, the other or a global amount.
- Advanced imaging such as CT, MRI and PET is often under separate pricing and prior-authorization policies that vary from state to state.
Timing matters too. 1 state set the current rate for 75958 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.
What managed-care plans pay for 75958
No managed-care plan publishes what it pays for 75958. 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.
Units and billing for 75958
75958 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.
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. Contrast agents and radiopharmaceuticals are usually billed separately under their own codes.
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.
Frequently asked questions
What does Medicaid pay for 75958?
It depends on the state. Of the 12 states with a published fee-for-service rate, the median is $151.48. Arkansas pays the most ($281.70) and Arizona the least ($1.00 per P).
Which state pays the highest Medicaid rate for 75958?
Arkansas, at $281.70, effective 2025-06-13.
Which state pays the lowest Medicaid rate for 75958?
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 75958 billed in?
Of the 12 states, 1 publish 75958 per p, and 11 schedules print no unit at all (a flat amount per service).
Do managed-care plans pay the same rate for 75958?
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.