California Medicaid Fee Schedule (Medi-Cal)
Medi-Cal publishes non-facility rates of $24.00 to $82.02 for 99213, depending on provider or program. Select the eligible rate below.
- Schedule as of
- September 2026
- Codes priced
- 11,296
Current Medi-Cal rates for common codes
Medi-Cal lists provider-specific rates in the September 2026 schedule. Select the rate type that applies to the claim; no median is used for codes with multiple types.
| Code | Service | Non-facility rate |
|---|---|---|
| 99213 | Office visit, established patient (low complexity)6 rate types
| $24.00 to $82.02By rate type |
| 99214 | Office visit, established patient (moderate complexity)6 rate types
| $37.50 to $115.88By rate type |
| 99203 | Office visit, new patient (low complexity)6 rate types
| $57.20 to $101.27By rate type |
| 99204 | Office visit, new patient (moderate complexity)6 rate types
| $68.90 to $151.90By rate type |
| 99285 | Emergency department visit, high severity with threat to function2 rate types
| $108.08By rate type |
See all 11,296 Medi-Cal codes, every schedule period, in the platform.
Book a 15-min Medicaid walkthroughSearch a CPT or HCPCS code
Compare any other code across state programs. The free view shows a few states per code; California's full schedule is in the complete dataset.
What to know about the Medi-Cal fee schedule
- Since 2024, Targeted Rate Increases pay eligible primary care, obstetric and non-specialty mental health services at least 87.5% of Medicare. DHCS: Medi-Cal Targeted Provider Rate Increases
- Medi-Cal managed care plans must pay eligible network providers at least the Targeted Rate Increase amounts. DHCS: Medi-Cal Targeted Provider Rate Increases DHCS APL 24-007
- Proposition 35 funds physician base rates at 87.5% of Medicare and supplemental payments rising from $116 million in 2025 to $835 million in 2026. LAO: 2025-26 California Spending Plan, Health DHCS: Proposition 35 code list
- Proposition 56 still funds add-on payments for family planning, developmental screening and ACEs trauma screening. DHCS: Proposition 56 Family Planning Services DHCS: Medi-Cal Targeted Provider Rate Increases
Medi-Cal fee schedule FAQ
Does a listed code mean the service is covered by Medi-Cal?
No. A listed Medi-Cal fee is not a coverage, authorization, or payment guarantee. Medi-Cal coverage, Treatment Authorization Request (TAR) and billing rules are set out in the Medi-Cal Provider Manual.
Does this California rate apply to Medicaid managed-care plans?
Medi-Cal is delivered mainly through Medi-Cal managed care plans: CMS reports 93.8% of California Medicaid enrollees were in some form of managed care in 2024. Plan rates are negotiated with providers and are not on this fee-for-service schedule. The fee-for-service rates apply when Medi-Cal pays a claim directly.
Why might my actual payment differ from the displayed rate?
These are the September 2026 Medi-Cal rates. A claim can pay a different amount because of the date of service, modifier, place of service, units billed, provider enrollment or taxonomy, bundling with another service, coverage policy, prior authorization, and claim edits.
Why is there no published rate for this code?
Medi-Cal lists some codes as "By Report": there is no fixed amount, and the claim is priced individually on review. Codes with a unit value of zero are not paid under this schedule. A code may also be bundled into another service or priced on a different Medi-Cal schedule. A missing rate does not mean the service is noncovered or pays $0.
Where can I find other Medi-Cal fee schedules?
Medi-Cal publishes separate fee schedules by provider type alongside the Medi-Cal Rates, physician and professional services, and its provider manual sets the coverage and billing rules.
Is the Medi-Cal fee schedule rate the whole payment for a physician service?
Not always. California layers extra payments on the base fee: Proposition 56 supplemental payments (for physician services through 2023, and still for programs such as family planning and developmental screening), the Targeted Rate Increases since 2024, and Proposition 35 add-ons funded by the MCO tax. Before comparing Medi-Cal to Medicare or commercial rates, check whether one applies to the code and date of service.
What are Medi-Cal's Targeted Rate Increases?
For dates of service from January 1, 2024, DHCS raised eligible primary care, obstetric and non-specialty mental health services to no less than 87.5% of Medicare. The increase absorbed the Prop 56 physician supplemental payments and removed the 2011 payment reductions for those services. Managed care plans must pay eligible network providers at least these amounts through a minimum fee schedule directed payment.
What happened to Prop 56 supplemental payments for physician services?
The Prop 56 physician services supplemental payment program ended on December 31, 2023, when those amounts were built into the Targeted Rate Increase fee schedule. For earlier dates of service, eligible physicians were paid the Medi-Cal fee plus the Prop 56 supplemental amount. Other Prop 56 programs, such as the family planning supplemental payments, continue as separate add-ons.
How does Proposition 35 affect Medi-Cal physician rates?
Proposition 35, approved by voters in November 2024, made the MCO tax permanent and directs part of its revenue to provider payments. The Legislative Analyst's Office reports the 2025-26 spending plan funds physician base rate increases to 87.5% of Medicare and supplemental physician payments of $116 million in 2025, rising to $835 million in 2026, with primary care and specialty care as the main targets.
Why can the same Medi-Cal code pay differently for children or in the ER?
Besides the basic rate, some codes carry a separate California Children's Services (CCS) rate that applies only when CCS authorized the service, and an emergency room rate that applies when the service is rendered in an emergency room. These conditional rates can differ from the basic rate for the same code, so the payment depends on authorization and setting, not just the code.
How does Medi-Cal pay codes that have no set rate?
Medi-Cal prices some codes 'By Report': there is no fixed amount, and the claim is priced individually on review. Submit documentation that supports the charge, such as an operative report or invoice, because the payment is set from what the reviewer can verify.
Neighboring and high-enrollment Medicaid fee schedules
States bordering California first, then the largest programs.