New Jersey Medicaid rate for CPT 99204
NJ FamilyCare pays a median of $127.28 across its rate types for CPT 99204 in its July 2026 fee-for-service schedule: the 19th-lowest of 45 state Medicaid programs, at 95% of the $134.20 median.
- Non-facility rate
- $127.28
- Rank
- 27 of 45
- vs. state median
- 95%
- vs. NJ Medicare
- 65-67%
What NJ FamilyCare publishes for 99204
19th-lowest of 45 · 95% of median
- Schedule
- July 2026
- In effect since
- Jul 1, 2026
$116.96 to $137.60 across 4 rate types
- Children Specialist or Purchase
- $137.60
- Fee Specialist or Purchase
- $137.60
- Children Non Specialist or Rental
- $116.96
- Fee Non Specialist or Rental
- $116.96
14 rate types
- Children Non Specialist or Rental and 1 more (FP + 52)
- $300.75
- Children Non Specialist or Rental and 3 more (FP + SB)
- $353.83
- Children Non Specialist or Rental and 1 more (FP)
- $300.75
- Children Non Specialist or Rental and 3 more (HF + SA)
- $197.44
- Children Non Specialist or Rental and 3 more (HF)
- $197.44
- Children Non Specialist or Rental and 3 more (SA)
- $116.96
- Children Non Specialist or Rental and 3 more (SB + 52)
- $137.60
- Children Non Specialist or Rental and 3 more (SB)
- $137.60
- Children Non Specialist or Rental (UC)
- $107.86
- Children Specialist or Purchase and 1 more (FP + 52)
- $353.83
- Children Specialist or Purchase and 1 more (FP)
- $353.83
- Children Specialist or Purchase (UC)
- $126.90
- Fee Non Specialist or Rental (UC)
- $142.17
- Fee Specialist or Purchase (UC)
- $167.26
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. NJMMIS Procedure Master
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. New Jersey |
|---|---|---|
| Delaware | $172.47 | +36% |
| Pennsylvania | $90.37 | -29% |
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 New Jersey is $189.20 to $196.57 across its 2 payment localities; NJ FamilyCare's rate is 65-67% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee New Jersey's full schedule: all 12,793 codes, every published period, and commercial payer rates for 99204.
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