Michigan Medicaid Fee Schedule
Michigan Medicaid pays $60.71 for an established-patient office visit (99213): 13th-lowest of 45 Medicaid programs, at 85% of the median. Its rates for the most-billed codes are below, ranked against every state.
- Schedule as of
- September 2026
- Codes priced
- 9,255
- 99213 vs. median
- 85% of median
Current Michigan Medicaid rates for common codes
Each amount is the unmodified non-facility rate in the September 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) | $60.7113th-lowest of 45 · 85% of median |
| 99214 | Office visit, established patient (moderate complexity) | $86.4814th-lowest of 45 · 85% of median |
| 99203 | Office visit, new patient (low complexity) | $74.9810th-lowest of 45 · 84% of median |
| 99204 | Office visit, new patient (moderate complexity) | $113.1012th-lowest of 45 · 84% of median |
| 99285 | Emergency department visit, high severity with threat to function3 rate types
| See rate choices |
Dot: Michigan. Tick: median across state programs. Line: lowest to highest state. Base fee-for-service rates; supplemental payments some states add are not included.
Michigan is 13th-lowest of 45 for 99213. See where all 9,255 Michigan Medicaid codes rank.
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Compare any other code across state programs. The free view shows a few states per code; Michigan's full schedule is in the complete dataset.
What to know about the Michigan Medicaid fee schedule
- Obstetric care pays 95% of Medicare, and inpatient neonatal and pediatric critical care pays 100% of the Medicare annual rate. Michigan Medicaid Provider Manual
- Eligible family medicine, internal medicine, pediatrics and general practice physicians get higher Primary Care Incentive rates for E/M visits. Michigan Medicaid Provider Manual
- Practitioners at Michigan public universities and Hurley Hospital get quarterly Physician Adjustor payments up to 100% of the average commercial rate. Michigan Medicaid Provider Manual
- Medicaid Health Plans must pay out-of-network providers the fee-for-service rate in effect on the date of service. Michigan Medicaid Provider Manual
Michigan Medicaid fee schedule FAQ
Does a listed code mean the service is covered by Michigan Medicaid?
No. A listed Michigan Medicaid fee is not a coverage, authorization, or payment guarantee. Coverage, prior authorization and billing rules are set out in the Michigan Medicaid Provider Manual, in its Practitioner chapter and Practitioner Reimbursement Appendix.
Does this Michigan rate apply to Medicaid managed-care plans?
Michigan contracts with Medicaid Health Plans (MHPs), which pay their network providers under their own contracts. The fee-for-service rates apply when Michigan Medicaid pays a claim directly. The Medicaid Provider Manual requires MHPs to pay out-of-network providers the fee-for-service rates in effect on the date of service.
Why might my actual payment differ from the displayed rate?
These are the September 2026 Michigan Medicaid 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?
Michigan calls its rates fee screens. Codes without an established fee screen are manually priced, either from claim documentation or through prior authorization. A code may also be bundled into another service or priced on a different Michigan Medicaid schedule. A missing rate does not mean the service is noncovered or pays $0.
Where can I find other Michigan Medicaid fee schedules?
Michigan Medicaid publishes separate fee schedules by provider type alongside the MDHHS Practitioner and Medical Clinic fee schedule, and its provider manual sets the coverage and billing rules.
Which Michigan Medicaid services are paid as a percentage of Medicare?
Several service lines are pegged to Medicare: obstetric antepartum, delivery and postpartum care at 95% (since October 2014), inpatient neonatal and pediatric critical care at 100% of the Medicare annual rate (since October 2022), and psychiatric diagnostic evaluation for people under 21 at 100% (since February 2020). Psychotherapy and other psychiatric services for under-21s are paid at 63% of Medicare (since January 2021).
Does Michigan pay primary care physicians more than the standard fee screen?
Yes. Since 2015, MDHHS 'applies an increased payment rate' for primary care services by family medicine, general internal medicine and pediatrics physicians (general practice since 2018) who are board certified or eligible, or have at least 60% of paid Medicaid codes in qualifying E/M codes. It covers office, nursing facility, home, preventive and online visits. NPs and PAs qualify through their collaborating physician; FQHCs, RHCs and health departments are excluded.
Do Michigan Medicaid Health Plans pay the enhanced primary care rate?
Eligible primary care physicians affiliated with a Medicaid Health Plan qualify for the primary care rate increase, identified by their Primary Care Provider status in the plan's network. MDHHS notes that the Primary Care Fee Schedule 'reflects rates that have been adjusted in compliance with funding levels established by state law', so the enhanced amount depends on each year's appropriation.
What is Michigan's Physician Adjustor program?
Practitioners employed by or contracted with the public entities named in the state plan, including the state university medical and dental faculties and Hurley Hospital, receive quarterly adjustments on fee-for-service claims. The adjustment can raise payment up to the practitioner's customary charge or 100% of the average commercial rate, whichever is less, and the public entities fund the state share.
Do Michigan Medicaid Health Plans have to pay the fee-for-service rate?
Only to providers outside their network. The Provider Manual states that 'MHPs reimburse out-of-network (non-contracted) providers at the Medicaid fee-for-service (FFS) rates in effect on the date of service', while contracted providers are paid under the terms of their subcontract with the plan.
How do Michigan Medicaid rates compare to Medicare?
The KFF Medicaid-to-Medicare fee index for 2024 puts Michigan at 0.73 for primary care, 0.88 for obstetric care, 0.66 for other services and 0.76 overall, against national averages of 0.66, 0.88, 0.84 and 0.75. Michigan's primary care index rose from 0.62 in 2019, but other services, which include most procedures, pay well below the national average.
Neighboring and high-enrollment Medicaid fee schedules
States bordering Michigan first, then the largest programs.