Fee-for-service rateAs of October 2026
Missouri Medicaid rate for CPT 99204
Office visit, new patient (moderate complexity)
MO HealthNet pays $138.56 for CPT 99204 in its October 2026 fee-for-service schedule: the 20th-highest of 45 state Medicaid programs, at 103% of the $134.20 median.
- Non-facility rate
- $138.56
- Rank
- 20 of 45
- vs. state median
- 103%
- vs. national Medicare
- 78%
What MO HealthNet publishes for 99204
20th-highest of 45 · 103% of median
20th-highest of 45 · 103% of median
- Schedule
- October 2026
- In effect since
- Jul 1, 2022
- Prior authorization
- Not required
7 rate types
- General and 1 more (EP)
- $138.56
- General (GE + EP)
- $138.56
- General and 1 more (GE)
- $138.56
- General (GT + EP)
- $138.56
- General (GT)
- $138.56
- General (HA)
- $138.56
- Podiatry (W2)
- $138.56
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. MO HealthNet Fee Schedules
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
99204 in every state
Map and ranking of every state program that prices 99204.
Compare 99204 across states99204 under Medicare
Medicare's 2026 national non-facility payment is $177.359; MO HealthNet's rate is 78% of it.
See 99204 Medicare ratesSee Missouri's full schedule: all 9,451 codes, every published period, and commercial payer rates for 99204.
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