Pennsylvania Medicaid rate for CPT 99204
Pennsylvania Medical Assistance pays $90.37 for CPT 99204 in its October 2026 fee-for-service schedule: the 3rd-lowest of 45 state Medicaid programs, at 67% of the $134.20 median.
- Non-facility rate
- $90.37
- Rank
- 43 of 45
- vs. state median
- 67%
- vs. PA Medicare
- 49-53%
What Pennsylvania Medical Assistance publishes for 99204
3rd-lowest of 45 · 67% of median
- Schedule
- October 2026
- In effect since
- Feb 17, 2025
3 rate types
- Telehealth and 4 more (FP)
- $90.37
- Telehealth and 3 more (TH)
- $90.37
- Telehealth and 4 more (U9)
- $90.37
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
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. Pennsylvania |
|---|---|---|
| Delaware | $172.47 | +91% |
| Maryland | $174.01 | +93% |
| New Jersey | $127.28 | +41% |
| Ohio | $93.36 | +3% |
| West Virginia | $122.98 | +36% |
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 Pennsylvania is $170.15 to $183.85 across its 2 payment localities; Pennsylvania Medical Assistance's rate is 49-53% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee Pennsylvania's full schedule: all 6,593 codes, every published period, and commercial payer rates for 99204.
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