Massachusetts Medicaid rate for CPT 99213
MassHealth pays $68.11 for CPT 99213 in its October 2026 fee-for-service schedule: the 19th-lowest of 45 state Medicaid programs, at 96% of the $71.05 median.
- Non-facility rate
- $68.11
- Rank
- 27 of 45
- vs. state median
- 96%
- vs. MA Medicare
- 64-70%
What MassHealth publishes for 99213
19th-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
99213 in neighboring states
Each state's comparable non-facility rate for 99213 in its current schedule.
| State | Rate | vs. Massachusetts |
|---|---|---|
| Connecticut | $63.80 | -6% |
| New Hampshire | $46.77 | -31% |
| Rhode Island | $97.30 | +43% |
| Vermont | $79.37 | +17% |
99213 in every state
Map and ranking of every state program that prices 99213.
Compare 99213 across states99213 under Medicare
Medicare's 2026 non-facility payment for 99213 in Massachusetts is $97.86 to $106.10 across its 2 payment localities; MassHealth's rate is 64-70% of that. The national amount before geographic adjustment is $95.193.
See 99213 Medicare ratesSee Massachusetts's full schedule: all 7,483 codes, every published period, and commercial payer rates for 99213.
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