Pennsylvania Medicaid rate for CPT 11042
Pennsylvania Medical Assistance pays $33.00 for CPT 11042 in its October 2026 fee-for-service schedule: the 3rd-lowest of 45 state Medicaid programs, at 34% of the $98.39 median.
- Non-facility rate
- $33.00
- Rank
- 43 of 45
- vs. state median
- 34%
- vs. PA Medicare
- 24-26%
What Pennsylvania Medical Assistance publishes for 11042
3rd-lowest of 45 · 34% of median
- Schedule
- October 2026
- In effect since
- Oct 1, 2023
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. DHS Outpatient Fee Schedule
11042 in neighboring states
Each state's comparable non-facility rate for 11042 in its current schedule.
| State | Rate | vs. Pennsylvania |
|---|---|---|
| Delaware | $128.88 | +291% |
| Maryland | $92.58 | +181% |
| New Jersey | $64.66 | +96% |
| Ohio | $66.97 | +103% |
| West Virginia | $88.82 | +169% |
11042 in every state
Map and ranking of every state program that prices 11042.
Compare 11042 across states11042 under Medicare
Medicare's 2026 non-facility payment for 11042 in Pennsylvania is $124.53 to $137.95 across its 2 payment localities; Pennsylvania Medical Assistance's rate is 24-26% of that. The national amount before geographic adjustment is $132.602.
See 11042 Medicare ratesSee Pennsylvania's full schedule: all 6,593 codes, every published period, and commercial payer rates for 11042.
Book a 15-min Medicaid walkthrough