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

99285 Medicaid Fee Schedule Rates by State

Compare 99285 (Emergency department visit, high severity with threat to function) 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.

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Current, state-published Medicaid fee-for-service rates; managed-care contracts are not included.See complete Medicaid history for 99285

99285 Emergency department visit, high severity with threat to function 131 published rates across 46 jurisdictions

Medicaid rate by state

99285each state's current schedule
Jurisdictions compared
46
Lowest comparable
$62.87
Median of 42
$138.69
Highest comparable
$323.58
Comparable spread
5.1x
Alaska: $323.58, effective July 2026Alabama: $272.74, effective September 2026Arkansas: $83.75, effective September 2026Arizona: $152.41 (median of $144.39 to $160.43 by rate type), effective October 2026California: non-facility rates $108.08 by provider, program, or modifier; exact rates are listed belowColorado: $140.64, effective July 2026Connecticut: $106.14, effective October 2026District of Columbia: no published rate for 99285Delaware: $166.73, effective January 2026Florida: no published rate for 99285Georgia: $132.41 (ordinary statewide rate; $132.41 to $177.20 by rate type), effective July 2026Hawaii: $166.55, effective June 2026Iowa: $135.92 (median of $121.64 to $143.10 by rate type), effective September 2026Idaho: $139.24, effective October 2026Illinois: $121.28, effective July 2026Indiana: $159.69, effective September 2026Kansas: $73.86 (median of $73.86 to $98.48 by rate type), effective October 2026Kentucky: $116.04, effective January 2026Louisiana: $144.29, effective July 2026Massachusetts: $127.50, effective October 2026Maryland: rate choices by provider, program, or modifier; exact rates are listed belowMaine: no published rate for 99285Michigan: rate choices by provider, program, or modifier; exact rates are listed belowMinnesota: $126.21, effective September 2026Missouri: $146.64, effective October 2026Mississippi: $147.73 (ordinary statewide rate; $147.73 to $164.14 by rate type), effective July 2026Montana: $236.63, effective January 2026North Carolina: $138.64, effective January 2026North Dakota: $181.74, effective August 2026Nebraska: $188.45, effective July 2026New Hampshire: $103.01, effective July 2026New Jersey: $119.36 (median of $109.68 to $129.03 by rate type), effective July 2026New Mexico: $255.43, effective March 2026Nevada: $176.04 (median of $111.18 to $176.04 by rate type), effective July 2026New York: no published rate for 99285Ohio: $94.23, effective January 2026Oklahoma: $154.91, effective July 2026Oregon: $134.60 (ordinary statewide rate; $134.60 to $141.50 by rate type), effective September 2026Pennsylvania: $138.74, effective October 2026Rhode Island: $92.55, effective October 2026South Carolina: $129.13 (ordinary statewide rate; $103.30 to $180.78 by rate type), effective October 2026South Dakota: $160.70, effective July 2026Texas: rate choices by provider, program, or modifier; exact rates are listed belowUtah: $140.13 (median of $132.20 to $148.06 by rate type), effective October 2026Virginia: $119.82, effective October 2026Vermont: $138.38, effective October 2026Washington: $99.18, effective October 2026Wisconsin: $62.87 (median of $59.56 to $66.18 by rate type), effective August 2026West Virginia: $126.15, effective April 2026Wyoming: $148.71, effective September 2026AK$323.58ALARAZ$152.41CA$108.08CO$140.64FLGAIAID$139.24ILINKS$73.86KYLAMEMIMN$126.21MO$146.64MSMT$236.63NCND$181.74NE$188.45NM$255.43NV$176.04NYOHOK$154.91OR$134.60PASCSD$160.70TN!TXRatesUT$140.13VAWA$99.18WIWVWY$148.71
Small states:CT$106.14DC—DE$166.73HI$166.55MA$127.50MDRatesNH$103.01NJ$119.36RI$92.55VT$138.38
No published rateRate choicesNot loaded yetNo schedule published

Ranked by rate

comparable median $138.69

Rate choices are placed by their lowest published non-facility fee.

  1. AK$323.58
  2. AL$272.74
  3. NM$255.43
  4. MT$236.63
  5. NE$188.45
  6. ND$181.74
  7. NV$176.04
  8. DE$166.73
  9. HI$166.55
  10. SD$160.70
  11. IN$159.69
  12. OK$154.91
  13. AZ$152.41
  14. WY$148.71
  15. MS$147.73
  16. MO$146.64
  17. LA$144.29
  18. CO$140.64
  19. UT$140.13
  20. ID$139.24
  21. PA$138.74
  22. NC$138.64
  23. VT$138.38
  24. IA$135.92
  25. OR$134.60
  26. GA$132.41
  27. SC$129.13
  28. MA$127.50
  29. MN$126.21
  30. WV$126.15
  31. IL$121.28
  32. VA$119.82
  33. NJ$119.36
  34. KY$116.04
  35. CA$108.08
  36. CT$106.14
  37. NH$103.01
  38. WA$99.18
  39. OH$94.23
  40. RI$92.55
  41. AR$83.75
  42. KS$73.86
  43. WI$62.87

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.

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42 jurisdictions with comparable rates for 99285

JurisdictionPrior authNon-facility rate
AlaskaJuly 2026Not published$323.58
AlabamaSeptember 2026Not required$272.74
New MexicoJan 1, 2025Not published$255.43
MontanaJul 1, 2025Not required$236.63
NebraskaJuly 2026Not required$188.45
North DakotaAugust 2026Not required$181.74
NevadaJan 1, 2024
$111.18 to $176.04 across 3 rate types
APRN · Rate type DEF
$176.04
Rate type DEF
$176.04
Physician Assistant · Rate type PR1
$111.18
Not published$176.04median across rate types
DelawareJanuary 2026Not published$166.73
HawaiiJune 2026Not published$166.55
South DakotaJul 1, 2026Not published$160.70
IndianaJan 1, 2026Not required$159.69
OklahomaJul 1, 2026Not published$154.91
ArizonaOct 1, 2026
$144.39 to $160.43 across 6 rate types
General
$160.43
Provider type 08
$160.43
Provider type 31
$160.43
Provider type 18
$144.39
Provider type 19
$144.39
Provider type CN
$144.39
Not published$152.41median across rate types
WyomingJul 1, 2026Not required$148.71
MississippiJul 1, 2026
$147.73 to $164.14 across 2 rate types
Primary Care Physician
$164.14
General
$147.73
Not published$147.73ordinary statewide rate
MissouriJul 1, 2022Not required$146.64
LouisianaJul 1, 2025Not required$144.29
ColoradoJul 1, 2026Not published$140.64
UtahJul 1, 2026
$132.20 to $148.06 across 2 rate types
Global (Rural)
$148.06
Global
$132.20
Not required$140.13median across rate types
IdahoJul 1, 2026Not required$139.24
PennsylvaniaSep 1, 2021Not published$138.74
North CarolinaOct 1, 2025Not published$138.64
VermontJan 1, 2026Not required$138.38
IowaJul 1, 2024
$121.64 to $143.10 across 5 rate types
General
$143.10
Provider type 03
$143.10
Provider type 38
$135.92
Provider type 68
$124.24
Provider type 50
$121.64
Not published$135.92median across rate types
OregonFeb 1, 2026
$134.60 to $141.50 across 2 rate types
Rate type P
$141.50
General
$134.60
Not published$134.60ordinary statewide rate
GeorgiaJul 1, 2021
$132.41 to $177.20 across 3 rate types
Enhanced rate · Midlevel Practitioners
$177.20
Enhanced rate · Physicians
$177.20
General
$132.41
Not published$132.41ordinary statewide rate
South CarolinaJul 1, 2024
$103.30 to $180.78 across 6 rate types
Pediatric Subspecialty
$180.78
Enhanced
$166.58
General
$129.13
Podiatry
$129.13
Nurse Midwife
$103.30
PA/NP
$103.30
Not published$129.13ordinary statewide rate
MassachusettsOct 1, 2026Not published$127.50
MinnesotaFeb 1, 2026Not published$126.21
West VirginiaApr 1, 2026Not published$126.15
IllinoisApr 1, 2024Not published$121.28
VirginiaJul 1, 2026Not required$119.82
New JerseyJul 1, 2026
$109.68 to $129.03 across 4 rate types
Children Specialist or Purchase
$129.03
Fee Specialist or Purchase
$129.03
Children Non Specialist or Rental
$109.68
Fee Non Specialist or Rental
$109.68
Not published$119.36median across rate types
KentuckyJanuary 2026Not published$116.04
ConnecticutJan 1, 2026Not required$106.14
New HampshireJul 1, 2023Not required$103.01
WashingtonOctober 2026Not published$99.18
OhioJan 1, 2024Not published$94.23
Rhode IslandJul 1, 2003Not published$92.55
ArkansasSeptember 2026Not published$83.75
KansasAug 1, 2024
$73.86 to $98.48 across 3 rate types
Allow 1 Unit
$98.48
Allow 1 Unit with Adjust · Exempt Physician · 75% of max fee
$73.86
Allow 1 Unit with Adjust · Mid Level Practitioner · 75% of max fee
$73.86
Not published$73.86median across rate types
WisconsinJan 1, 2024
$59.56 to $66.18 across 2 rate types
Rate type MED · 5 provider specialties · 7 places of service
$66.18
Rate type PT1 · 2 provider specialties · 7 places of service
$59.56
Not published$62.87median across rate types

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.

JurisdictionRate typeModifiersNon-facility rateFacility rate
California
2 rate contexts at this amount
Medicine (Physician)
Podiatrist
None$108.08$108.08
CaliforniaMedicine (Physician) · Hospital Emergency RoomNone—$108.08
KentuckyStandard rateNone—$116.04
MarylandGeneralNone—$179.07
MarylandPCPNone—$183.06
Michigan
3 rate contexts at this amount
General
Nurse Midwife
Podiatry
UA—$103.19
Michigan
3 rate contexts at this amount
General
Nurse Midwife
Podiatry
UD—$76.03
Michigan
3 rate contexts at this amount
General
Nurse Midwife
Podiatry
None—$109.27
New HampshireGeneralHE$186.79—
New HampshireGeneralHW + U1$186.79—
New HampshireGeneralHW + U2$186.79—
New HampshireGeneralHW + U5$186.79—
New HampshireGeneralHW + U6$186.79—
New HampshireGeneralHW + U7$186.79—
Pennsylvania
2 rate contexts at this amount
Telehealth
Hospital ER
TH$138.74—
Rhode IslandLevel 3 · PAC I · Up to 1 unit25$92.55—
Rhode IslandLevel 3 · PAC I · Up to 1 unitGC$92.55—
South CarolinaEnhancedFP$166.58$166.58
South CarolinaEnhancedGT$166.58$166.58
South CarolinaEnhancedP4$169.29$169.29
South CarolinaGeneralFP$129.13$129.13
South Carolina
2 rate contexts at this amount
General
Podiatry
GT$129.13$129.13
South CarolinaGeneralP4$131.23$131.23
South Carolina
2 rate contexts at this amount
Nurse Midwife
PA/NP
FP$103.30$103.30
South Carolina
2 rate contexts at this amount
Nurse Midwife
PA/NP
GT$103.30$103.30
South CarolinaPA/NPP4$104.99$104.99
South CarolinaPediatric SubspecialtyFP$180.78$180.78
South CarolinaPediatric SubspecialtyGT$180.78$180.78
South CarolinaPediatric SubspecialtyP4$183.72$183.72
TexasMedical Services · Under 21None—$118.70
TexasMedical Services · Ages 21+None—$101.00
Wisconsin
2 rate contexts at this amount
Rate type MED · 6 provider specialties · Under 19 · 7 places of service · Payment adjustment
Rate type MED · 5 provider specialties · Ages 19+ · 7 places of service
TJ$66.18—
Wisconsin
8 rate contexts at this amount
Rate type MED · 17 provider specialties · Under 19 · 7 places of service · HPSA adjustment
Rate type MED · 17 provider specialties · Under 19 · 7 places of service · Payment adjustment
Rate type MED · 17 provider specialties · Ages 19+ · 7 places of service
Rate type MED · 17 provider specialties · Ages 19+ · 7 places of service · HPSA adjustment
Rate type MED · 17 provider specialties · 7 places of service
Rate type MED · 55 provider specialties · Under 19 · 7 places of service · Payment adjustment
Rate type MED · 54 provider specialties · Ages 19+ · 7 places of service
Rate type MED · 54 provider specialties · 7 places of service
AQ$66.18—
Wisconsin
5 rate contexts at this amount
Rate type PT1 · 2 provider specialties · Ages 19+ · 7 places of service
Rate type PT1 · 2 provider specialties · 7 places of service
Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 7 places of service · HPSA adjustment
Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 7 places of service · Payment adjustment
Rate type PT1 · Provider type 10, specialty 100 · Ages 19+ · 7 places of service · HPSA adjustment
AQ$59.56—
Wisconsin
2 rate contexts at this amount
Rate type PT1 · 2 provider specialties · Ages 19+ · 7 places of service
Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 7 places of service · Payment adjustment
TJ$59.56—

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

99285 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.gov
Looking for Medicare rates? Search the Medicare fee schedule.