Massachusetts Medicaid rate for CPT 99204
MassHealth pays $128.18 for CPT 99204 in its October 2026 fee-for-service schedule: the 21st-lowest of 45 state Medicaid programs, at 96% of the $134.20 median.
- Non-facility rate
- $128.18
- Rank
- 25 of 45
- vs. state median
- 96%
- vs. MA Medicare
- 65-71%
What MassHealth publishes for 99204
21st-lowest of 45 · 96% of median
- Schedule
- October 2026
- In effect since
- Oct 1, 2026
Unmodified non-facility fee-for-service rate from the state's published file. Managed-care contracts, supplemental payments, and claim-specific adjustments can change what is paid. 101 CMR 317.00, Rates for Medicine Services
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. Massachusetts |
|---|---|---|
| Connecticut | $116.98 | -9% |
| New Hampshire | $69.90 | -45% |
| Rhode Island | $180.87 | +41% |
| Vermont | $194.21 | +52% |
99204 in every state
Map and ranking of every state program that prices 99204.
Compare 99204 across states99204 under Medicare
Medicare's 2026 non-facility payment for 99204 in Massachusetts is $181.49 to $196.04 across its 2 payment localities; MassHealth's rate is 65-71% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee Massachusetts's full schedule: all 7,483 codes, every published period, and commercial payer rates for 99204.
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