Rates through October 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. Comparable rankings use unmodified non-facility rates; provider, program, and modifier-specific fees appear as labeled ranges or separate choices.
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.
Available data
50
Jurisdictions covered
17,674
Distinct codes
974,327
Published rates
5
Codes free in all 50 jurisdictions
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) 383 published rates across 46 jurisdictions
Medicaid rate by state
99204each state's current schedule
- Jurisdictions compared
- 46
- Lowest comparable
- $69.90
- Median of 45
- $134.20
- Highest comparable
- $309.91
- Comparable spread
- 4.4x
Small states:CT$116.98DC—DE$172.47HI$131.20MA$128.18MD$174.01NH$69.90NJ$127.28RI$180.87VT$194.21
No published rateRate choicesNot loaded yetNo schedule published
Ranked by rate
comparable median $134.20Rate choices are placed by their lowest published non-facility fee.
- AK$309.91
- AL$251.30
- NM$238.74
- MT$229.09
- VT$194.21
- ND$194.13
- NE$182.41
- RI$180.87
- MD$174.01
- DE$172.47
- NV$170.64
- SD$166.01
- ID$159.87
- OK$156.12
- IN$153.78
- MS$147.42
- WY$145.21
- UT$142.78
- OR$141.95
- MO$138.56
- MN$136.71
- LA$134.57
- CO$134.20
- HI$131.20
- MA$128.18
- VA$127.86
- NJ$127.28
- NC$125.39
- WV$122.98
- SC$122.26
- KS$120.26
- CT$116.98
- IA$114.87
- MI$113.10
- KY$112.27
- AZ$111.91
- WI$110.94
- GA$110.51
- WA$98.53
- AR$95.17
- OH$93.36
- IL$90.81
- PA$90.37
- TX$88.35
- NH$69.90
- CA$68.90to $151.90
Blue states show comparable rates or published rate choices. Use the exact rate type below.
Rate history for one state
Select a state on the map to see how its rate has moved - the platform holds 195 published periods back to 2001. 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 2001 for all 17,674 codes, is in the platform.
Book a 15-min Medicaid walkthrough45 jurisdictions with comparable rates for 99204
| Jurisdiction | Prior auth | Non-facility rate |
|---|---|---|
| AlaskaJuly 2026 | Not published | $309.91 |
| AlabamaSeptember 2026 | Not required | $251.30 |
| New MexicoJan 1, 2025 | Not published | $238.74 |
| MontanaJul 1, 2025 | Not required | $229.09 |
VermontJul 1, 2026$146.88 to $241.54 across 2 rate types
| Not required | $194.21median across rate types |
| North DakotaAugust 2026 | Not required | $194.13 |
| NebraskaJuly 2026 | Not required | $182.41 |
| Rhode IslandJul 1, 2026 | Not published | $180.87 |
MarylandSeptember 2026$174.01 to $178.20 across 2 rate types
| Not required | $174.01ordinary statewide rate |
| DelawareJanuary 2026 | Not published | $172.47 |
NevadaJan 1, 2024$107.77 to $170.64 across 3 rate types
| Not published | $170.64median across rate types |
| South DakotaJul 1, 2026 | Not published | $166.01 |
| IdahoJul 1, 2026 | Not required | $159.87 |
| OklahomaJul 1, 2026 | Not published | $156.12 |
| IndianaJan 1, 2026 | Not required | $153.78 |
MississippiJul 1, 2026$147.42 to $163.80 across 2 rate types
| Not published | $147.42ordinary statewide rate |
WyomingJul 1, 2026$145.21 to $191.49 across 3 rate types
| Not required | $145.21ordinary statewide rate |
UtahJul 1, 2026$134.70 to $150.86 across 2 rate types
| Not required | $142.78median across rate types |
OregonFeb 1, 2026$141.95 to $149.23 across 2 rate types
| Not published | $141.95ordinary statewide rate |
| MissouriJul 1, 2022 | Not required | $138.56 |
| MinnesotaFeb 1, 2026 | Not published | $136.71 |
| LouisianaJul 1, 2025 | Not required | $134.57 |
| ColoradoJul 1, 2026 | Not published | $134.20 |
| HawaiiJune 2026 | Not published | $131.20 |
| MassachusettsOct 1, 2026 | Not published | $128.18 |
VirginiaJul 1, 2026$127.79 to $127.93 across 2 rate types
| Not required | $127.86median across rate types |
New JerseyJul 1, 2026$116.96 to $137.60 across 4 rate types
| Not published | $127.28median across rate types |
| North CarolinaOct 1, 2025 | Not published | $125.39 |
| West VirginiaApr 1, 2026 | Not published | $122.98 |
South CarolinaJul 1, 2024$97.81 to $171.16 across 6 rate types
| Not published | $122.26ordinary statewide rate |
KansasAug 1, 2024$90.20 to $120.26 across 3 rate types
| Not published | $120.26ordinary statewide rate |
ConnecticutJan 1, 2026$103.99 to $199.31 across 4 rate types
| Not required | $116.98median across rate types |
IowaJul 1, 2024$100.15 to $117.82 across 6 rate types
| Not published | $114.87median across rate types |
| MichiganSeptember 2026 | Not published | $113.10 |
| KentuckyJanuary 2026 | Not published | $112.27 |
ArizonaOct 1, 2024$106.28 to $124.35 across 7 rate types
| Not published | $111.91median across rate types |
WisconsinJan 1, 2024$99.86 to $110.94 across 10 rate types
| Not published | $110.94median across rate types |
GeorgiaJul 1, 2021$110.51 to $167.09 across 2 rate types
| Not published | $110.51ordinary statewide rate |
WashingtonOctober 2026$79.07 to $117.99 across 2 rate types
| Conditional | $98.53median across rate types |
| ArkansasSeptember 2026 | Not published | $95.17 |
| OhioJan 1, 2024 | Not published | $93.36 |
| IllinoisApr 1, 2024 | Not published | $90.81 |
| PennsylvaniaFeb 17, 2025 | Not published | $90.37 |
TexasSep 1, 2023$81.24 to $95.47 across 4 rate types
| Not published | $88.35median across rate types |
| New HampshireJul 1, 2023 | Not required | $69.90 |
Rates by provider, program, modifier, or setting
Check the rate type, modifiers, and place of service before using an amount. These amounts are not interchangeable.
| Jurisdiction | Rate type | Modifiers | Non-facility rate | Facility rate |
|---|---|---|---|---|
| Arkansas | General | TH | $161.79 | — |
| Arkansas | General | X2 | $92.40 | — |
| Arkansas | General | X4 | $92.40 | — |
| California | 3 rate contexts at this amount
| None | $68.90 | $68.90 |
| California | Allied Health Other Programs · Hospital Emergency Room | None | — | $68.90 |
| California | 2 rate contexts at this amount
| None | $151.90 | $151.90 |
| California | Justice Involved · Hospital Emergency Room | None | — | $151.90 |
| California | 2 rate contexts at this amount
| None | $75.17 | $75.17 |
| California | Medicine (Physician) · Hospital Emergency Room | None | — | $85.57 |
| Colorado | Family Planning Professional | FP + GT | $205.55 | — |
| Colorado | Family Planning Professional | FP | $200.09 | — |
| Colorado | General | GT | $139.10 | — |
| Connecticut | Rate type FTM | None | — | $81.54 |
| Connecticut | Rate type FTO | None | — | $156.29 |
| Connecticut | Rate type FTP | None | — | $101.93 |
| Illinois | Prenatal Subsequent | U5 | $104.96 | — |
| Indiana | General | SE | $153.78 | $122.16 |
| Kansas | Max Fee | TD | $110.33 | — |
| Kansas | 2 rate contexts at this amount
| TD | $82.75 | — |
| Kentucky | Standard rate | None | — | $102.79 |
| Louisiana | 2 rate contexts at this amount
| TH | $134.57 | — |
| Missouri | 2 rate contexts at this amount
| EP | $138.56 | — |
| Missouri | General | GE + EP | $138.56 | — |
| Missouri | 2 rate contexts at this amount
| GE | $138.56 | — |
| Missouri | General | GT + EP | $138.56 | — |
| Missouri | General | GT | $138.56 | — |
| Missouri | General | HA | $138.56 | — |
| Missouri | Podiatry | W2 | $138.56 | — |
| Nebraska | General | EP | $182.41 | — |
| New Hampshire | General | 33 | $87.75 | — |
| New Hampshire | General | GY + HE | $166.45 | — |
| New Hampshire | General | GY + HW + U1 | $166.45 | — |
| New Hampshire | General | GY + HW + U2 | $166.45 | — |
| New Hampshire | General | GY + HW + U5 | $166.45 | — |
| New Hampshire | General | GY + HW + U6 | $166.45 | — |
| New Hampshire | General | GY + HW + U7 | $166.45 | — |
| New Hampshire | General | HE | $166.45 | — |
| New Hampshire | General | HF | $252.18 | — |
| New Hampshire | General | HW + U1 | $166.45 | — |
| New Hampshire | General | HW + U2 | $166.45 | — |
| New Hampshire | General | HW + U5 | $166.45 | — |
| New Hampshire | General | HW + U6 | $166.45 | — |
| New Hampshire | General | HW + U7 | $166.45 | — |
| New Hampshire | General | U1 | $252.18 | — |
| New Jersey | 2 rate contexts at this amount
| FP + 52 | $300.75 | — |
| New Jersey | 4 rate contexts at this amount
| FP + SB | $353.83 | — |
| New Jersey | 2 rate contexts at this amount
| FP | $300.75 | — |
| New Jersey | 4 rate contexts at this amount
| HF + SA | $197.44 | — |
| New Jersey | 4 rate contexts at this amount
| HF | $197.44 | — |
| New Jersey | 4 rate contexts at this amount
| SA | $116.96 | — |
| New Jersey | 4 rate contexts at this amount
| SB + 52 | $137.60 | — |
| New Jersey | 4 rate contexts at this amount
| SB | $137.60 | — |
| New Jersey | Children Non Specialist or Rental | UC | $107.86 | — |
| New Jersey | 2 rate contexts at this amount
| FP + 52 | $353.83 | — |
| New Jersey | 2 rate contexts at this amount
| FP | $353.83 | — |
| New Jersey | Children Specialist or Purchase | UC | $126.90 | — |
| New Jersey | Fee Non Specialist or Rental | UC | $142.17 | — |
| New Jersey | Fee Specialist or Purchase | UC | $167.26 | — |
| Nevada | 2 rate contexts at this amount
| U6 | $85.32 | — |
| Nevada | Physician Assistant · Rate type PR1 | U6 | $53.89 | — |
| Pennsylvania | 5 rate contexts at this amount
| FP | $90.37 | — |
| Pennsylvania | 4 rate contexts at this amount
| TH | $90.37 | — |
| Pennsylvania | 5 rate contexts at this amount
| U9 | $90.37 | — |
| Rhode Island | Level 3 · PAC I · Up to 1 unit | 25 | $180.87 | — |
| Rhode Island | Level 3 · PAC I · Up to 1 unit | GA | $180.87 | — |
| Rhode Island | Level 3 · PAC I · Up to 1 unit | GE | $180.87 | — |
| Rhode Island | Level 3 · PAC I · Up to 1 unit | GT | $180.87 | — |
| Rhode Island | Level 4 · PAC S · Up to 1 unit | U8 | $153.74 | — |
| South Carolina | Enhanced | FP | $157.71 | $126.13 |
| South Carolina | Enhanced | GT | $157.71 | $126.13 |
| South Carolina | Enhanced | P4 | $158.14 | $125.40 |
| South Carolina | General | FP | $122.26 | $97.77 |
| South Carolina | 2 rate contexts at this amount
| GT | $122.26 | $97.77 |
| South Carolina | General | P4 | $122.59 | $97.21 |
| South Carolina | 2 rate contexts at this amount
| FP | $97.81 | $78.22 |
| South Carolina | 2 rate contexts at this amount
| GT | $97.81 | $78.22 |
| South Carolina | Nurse Midwife | SB | $98.07 | $77.77 |
| South Carolina | PA/NP | P4 | $98.07 | $77.77 |
| South Carolina | Pediatric Subspecialty | FP | $171.16 | $136.88 |
| South Carolina | Pediatric Subspecialty | GT | $171.16 | $136.88 |
| South Carolina | Pediatric Subspecialty | P4 | $171.63 | $136.09 |
| Texas | Medical Services · Under 21 | FP | $90.07 | $90.07 |
| Texas | Medical Services · Ages 10-20 | TH | $95.47 | $95.47 |
| Texas | Medical Services · Ages 21-55 | TH | $81.24 | $81.24 |
| Texas | Medical Services · Ages 21+ | FP | $81.24 | $81.24 |
| Virginia | Under 21 | None | — | $84.23 |
| Virginia | Ages 21+ | None | — | $84.32 |
| Wisconsin | 49 rate contexts at this amount
| AQ | $110.94 | — |
| Wisconsin | 24 rate contexts at this amount
| TJ | $110.94 | — |
| Wisconsin | 12 rate contexts at this amount
| TH | $110.94 | — |
| Wisconsin | 6 rate contexts at this amount
| AQ + TH | $110.94 | — |
| Wisconsin | 25 rate contexts at this amount
| AQ | $99.86 | — |
| Wisconsin | 12 rate contexts at this amount
| TJ | $99.86 | — |
| Wisconsin | 4 rate contexts at this amount
| TH | $99.86 | — |
| Wisconsin | 2 rate contexts at this amount
| AQ + TH | $99.86 | — |
Labels summarize each state's published rate context. Provider specialty lists, place-of-service lists and adjustment codes are in the full dataset. See the full context in the platform
What commercial payers pay for 99204
Compare this state-published Medicaid fee-for-service amount with the negotiated commercial rates payers have published for the same code.
99204 Medicaid rates in high-enrollment states
Open a state schedule for its current rate, effective period, methodology, and official source.
CaliforniaMedi-Cal - September 2026TexasTexas Medicaid - September 2026PennsylvaniaPennsylvania Medical Assistance - October 2026IllinoisIllinois Medicaid - July 2026North CarolinaNC Medicaid - January 2026OhioOhio Medicaid - January 2026MichiganMichigan Medicaid - September 2026GeorgiaGeorgia Medicaid - July 2026
No comparable statewide physician fee schedule is available for Tennessee. Why.
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, rate type, 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.govLooking for Medicare rates? Search the Medicare fee schedule.