D3431 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for D3431, 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. 3 of the 5 states list more than one rate for D3431, 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. None of the 5 schedules prints a separate unit for D3431, so each amount is a flat payment for one service as the code defines it.
• Per hour. D3431 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 D3431, 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.

Published rates for D3431 run from $7.23 in South Dakota to $581.48 in Wyoming, a 80.5x gap in the same unit. Half the states pay more than the median of $7.23 and half pay less. The usual reasons for a spread like this in hospital outpatient rates:

• States pay outpatient hospital care under different systems: grouped payments, a fee schedule or a percentage of charges.
• Many outpatient amounts are hospital-specific or adjusted by hospital type.

Timing matters too. 4 states set the current rate for D3431 in 2026 or later, while 1 state 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 a plan pays for D3431 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 5 states.

In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. The rule for the remaining 4 states is not classified yet.

• Plans must pay at least the published rate (1 state). 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 Wyoming managed care.

D3431 is a CDT dental code in the hospital outpatient line, billed mostly by hospital outpatient departments. CDT codes are maintained by the American Dental Association. Each is paid once per procedure, with the tooth number and surfaces on the claim, and many states publish separate child and adult amounts.

Outpatient services are billed per procedure, and some systems package lower-cost items into the payment for the main service.

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.