Massachusetts Medicaid Fee Schedule (MassHealth)
MassHealth pays $68.11 for an established-patient office visit (99213): 19th-lowest of 45 Medicaid programs, at 96% of the median. Its rates for the most-billed codes are below, ranked against every state.
- Schedule as of
- October 2026
- Codes priced
- 7,483
- 99213 vs. median
- 96% of median
Current MassHealth rates for common codes
Each amount is the unmodified non-facility rate in the October 2026 schedule. Where a code appears under more than one rate type, it is the state's ordinary statewide rate when its rules name one, and otherwise the median across rate types. Modifier-specific and facility-only rows are listed separately under the service.
| Code | Service | Non-facility rate |
|---|---|---|
| 99213 | Office visit, established patient (low complexity) | $68.11In effect since Oct 1, 202619th-lowest of 45 · 96% of median |
| 99214 | Office visit, established patient (moderate complexity) | $96.15In effect since Oct 1, 202619th-lowest of 45 · 95% of median |
| 99203 | Office visit, new patient (low complexity) | $84.36In effect since Oct 1, 202619th-lowest of 45 · 94% of median |
| 99204 | Office visit, new patient (moderate complexity) | $128.18In effect since Oct 1, 202621st-lowest of 45 · 96% of median |
| 99285 | Emergency department visit, high severity with threat to function | $127.50In effect since Oct 1, 202615th-lowest of 42 · 92% of median |
Dot: Massachusetts. Tick: median across state programs. Line: lowest to highest state. Base fee-for-service rates; supplemental payments some states add are not included.
Massachusetts is 19th-lowest of 45 for 99213. See where all 7,483 MassHealth codes rank.
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Compare any other code across state programs. The free view shows a few states per code; Massachusetts's full schedule is in the complete dataset.
Neighboring and high-enrollment Medicaid fee schedules
States bordering Massachusetts first, then the largest programs.