North Carolina Medicaid rate for CPT 99204
NC Medicaid pays $125.39 for CPT 99204 in its January 2026 fee-for-service schedule: the 18th-lowest of 45 state Medicaid programs, at 93% of the $134.20 median.
- Non-facility rate
- $125.39
- Rank
- 28 of 45
- vs. state median
- 93%
- vs. NC Medicare
- 74%
What NC Medicaid publishes for 99204
18th-lowest of 45 · 93% of median
- Schedule
- January 2026
- In effect since
- Oct 1, 2025
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. NC Medicaid Physician Services Fee Schedules
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. North Carolina |
|---|---|---|
| Georgia | $110.51 | -12% |
| South Carolina | $122.26 | -2% |
| Virginia | $127.86 | +2% |
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 North Carolina is $168.94; NC Medicaid's rate is 74% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee North Carolina's full schedule: all 8,402 codes, every published period, and commercial payer rates for 99204.
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