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Rates through August 2026State-published files · No login required

99204 Medicaid Fee Schedule Rates by State

Compare 99204 (Office visit, new patient (moderate complexity)) across covered Medicaid fee-for-service physician schedules. Each figure is the median unmodified non-facility amount in that jurisdiction's latest published schedule.

These are agency-published fee-for-service amounts, not managed-care contracted rates or a guarantee of payment. The free view shows all covered jurisdictions for 99213, 99214, 99203, 99204, 99285 and up to 8 jurisdictions for other published codes.

Current, state-published Medicaid fee-for-service rates; managed-care contracts are not included.See complete Medicaid history for 99204

99204 Office visit, new patient (moderate complexity) 111 published rates across 46 jurisdictions

Medicaid rate by state

99204each state's current schedule
Jurisdictions publishing
46
Lowest
$68.90
Median
$128.06
Highest
$309.91
Spread
4.5x
Alaska: $309.91, effective July 2026Alabama: $127.04, effective April 2026Arkansas: $95.17, effective August 2026Arizona: $118.09, effective October 2025California: $68.90, effective April 2026Colorado: no published rate for 99204Connecticut: $103.99, effective July 2026District of Columbia: $158.11, effective April 2026Delaware: $172.47, effective January 2026Florida: $137.94, effective January 2026Georgia: $110.51, effective July 2026Hawaii: $131.20, effective June 2026Iowa: $117.82, effective August 2026Idaho: $152.59, effective July 2025Illinois: $90.81, effective July 2026Indiana: $153.78, effective August 2026Kansas: $120.26, effective August 2026Kentucky: $112.27, effective January 2026Louisiana: $134.57, effective January 2026Massachusetts: $128.18, effective January 2026MD: not covered yet - its fee schedule is not in the datasetMaine: $121.44, effective January 2026Michigan: $113.10, effective July 2026Minnesota: $136.71, effective August 2026Missouri: $138.56, effective July 2026Mississippi: $147.42, effective July 2026Montana: $229.09, effective January 2026North Carolina: $125.39, effective January 2026North Dakota: $194.13, effective July 2026Nebraska: $182.41, effective July 2026New Hampshire: $69.90, effective January 2026New Jersey: $116.96, effective July 2026New Mexico: $238.74, effective March 2026Nevada: $170.64, effective July 2026New York: $159.19, effective July 2026Ohio: $93.36, effective January 2026Oklahoma: $156.24, effective July 2026Oregon: $141.95, effective July 2026Pennsylvania: $90.37, effective August 2026RI: not covered yet - its fee schedule is not in the datasetSouth Carolina: $122.26, effective August 2026South Dakota: $166.01, effective July 2026TN: not covered yet - its fee schedule is not in the datasetTexas: $81.24, effective July 2026Utah: $142.78, effective July 2026Virginia: $127.93, effective August 2026Vermont: $146.88, effective August 2026Washington: $117.99, effective July 2026Wisconsin: $110.94, effective August 2026West Virginia: $122.98, effective April 2026WY: not covered yet - its fee schedule is not in the datasetAK$309.91ALARAZ$118.09CA$68.90COFLGAIAID$152.59ILINKS$120.26KYLAMEMIMN$136.71MO$138.56MSMT$229.09NCND$194.13NE$182.41NM$238.74NV$170.64NYOHOK$156.24OR$141.95PASCSD$166.01TNTX$81.24UT$142.78VAWA$117.99WIWVWY
Small states:CT$103.99DC$158.11DE$172.47HI$131.20MA$128.18MD—NH$69.90NJ$116.96RI—VT$146.88No published rateNot covered yet

Ranked by rate

median $128.06
  1. AK$309.91
  2. NM$238.74
  3. MT$229.09
  4. ND$194.13
  5. NE$182.41
  6. DE$172.47
  7. NV$170.64
  8. SD$166.01
  9. NY$159.19
  10. DC$158.11
  11. OK$156.24
  12. IN$153.78
  13. ID$152.59
  14. MS$147.42
  15. VT$146.88
  16. UT$142.78
  17. OR$141.95
  18. MO$138.56
  19. FL$137.94
  20. MN$136.71
  21. LA$134.57
  22. HI$131.20
  23. MA$128.18
  24. VA$127.93
  25. AL$127.04
  26. NC$125.39
  27. WV$122.98
  28. SC$122.26
  29. ME$121.44
  30. KS$120.26
  31. AZ$118.09
  32. WA$117.99
  33. IA$117.82
  34. NJ$116.96
  35. MI$113.10
  36. KY$112.27
  37. WI$110.94
  38. GA$110.51
  39. CT$103.99
  40. AR$95.17
  41. OH$93.36
  42. IL$90.81
  43. PA$90.37
  44. TX$81.24
  45. NH$69.90
  46. CA$68.90

Each state shows the rate from the most recent schedule it has published. States update on their own cadence.

Rate history for one state

Select a state on the map to see how its rate has moved - the platform holds 105 published periods back to 2003. Not part of the free view.

Historical rates are part of the platform

The table behind this panel shows the fields available in historical schedules; it does not display synthetic dates or rates. The real history, every published schedule back to 2003 for all 16,344 codes, is in the platform.

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99204 Medicaid rates in high-enrollment states

Open a state schedule for its current rate, effective period, methodology, and official source.

CaliforniaMedi-Cal - April 2026New YorkNY Medicaid - July 2026TexasTexas Medicaid - July 2026FloridaFlorida Medicaid - January 2026PennsylvaniaPennsylvania Medical Assistance - August 2026IllinoisIllinois Medicaid - July 2026North CarolinaNC Medicaid - January 2026OhioOhio Medicaid - January 2026MichiganMichigan Medicaid - July 2026GeorgiaGeorgia Medicaid - July 2026

Methodology

Each jurisdiction's published Medicaid fee-for-service physician schedule is downloaded at the source, parsed, and normalized into a shared schema of jurisdiction, effective period, section, code, modifier, non-facility rate, and facility rate. Rates are carried through unchanged - no averaging, interpolation, or cross-jurisdiction adjustment is applied. Where a program publishes a single rate for both settings, the same value appears in both columns. Managed-care contracts, eligibility, coverage rules, modifiers not shown, and claim-specific adjustments can produce different payment.

Medicaid benefits and coverage at Medicaid.gov
Looking for Medicare rates? Search the Medicare fee schedule.