Pennsylvania Medicaid rate for CPT 99213
Pennsylvania Medical Assistance pays $35.00 for CPT 99213 in its October 2026 fee-for-service schedule: the lowest of 45 state Medicaid programs, at 49% of the $71.05 median.
- Non-facility rate
- $35.00
- Rank
- 45 of 45
- vs. state median
- 49%
- vs. PA Medicare
- 36-38%
What Pennsylvania Medical Assistance publishes for 99213
Lowest of 45 · 49% of median
- Schedule
- October 2026
- In effect since
- Feb 17, 2025
5 rate types
- Telehealth and 4 more (FP)
- $35.00
- Telehealth and 3 more (TH)
- $35.00
- Telehealth and 2 more (U5)
- $16.00
- Telehealth and 3 more (U6)
- $35.00
- Telehealth and 4 more (U9)
- $40.00
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
99213 in neighboring states
Each state's comparable non-facility rate for 99213 in its current schedule.
| State | Rate | vs. Pennsylvania |
|---|---|---|
| Delaware | $92.63 | +165% |
| Maryland | $94.62 | +170% |
| New Jersey | $68.59 | +96% |
| Ohio | $46.23 | +32% |
| West Virginia | $65.15 | +86% |
99213 in every state
Map and ranking of every state program that prices 99213.
Compare 99213 across states99213 under Medicare
Medicare's 2026 non-facility payment for 99213 in Pennsylvania is $91.03 to $98.55 across its 2 payment localities; Pennsylvania Medical Assistance's rate is 36-38% of that. The national amount before geographic adjustment is $95.193.
See 99213 Medicare ratesSee Pennsylvania's full schedule: all 6,593 codes, every published period, and commercial payer rates for 99213.
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