Pennsylvania Medicaid rate for CPT 12001
Pennsylvania Medical Assistance pays $24.50 for CPT 12001 in its October 2026 fee-for-service schedule: the lowest of 45 state Medicaid programs, at 28% of the $86.45 median.
- Non-facility rate
- $24.50
- Rank
- 45 of 45
- vs. state median
- 28%
- vs. PA Medicare
- 21-23%
What Pennsylvania Medical Assistance publishes for 12001
Lowest of 45 · 28% 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
12001 in neighboring states
Each state's comparable non-facility rate for 12001 in its current schedule.
| State | Rate | vs. Pennsylvania |
|---|---|---|
| Delaware | $110.53 | +351% |
| Maryland | $88.44 | +261% |
| New Jersey | $69.05 | +182% |
| Ohio | $70.72 | +189% |
| West Virginia | $76.86 | +214% |
12001 in every state
Map and ranking of every state program that prices 12001.
Compare 12001 across states12001 under Medicare
Medicare's 2026 non-facility payment for 12001 in Pennsylvania is $106.97 to $118.85 across its 2 payment localities; Pennsylvania Medical Assistance's rate is 21-23% of that. The national amount before geographic adjustment is $113.897.
See 12001 Medicare ratesSee Pennsylvania's full schedule: all 6,593 codes, every published period, and commercial payer rates for 12001.
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