South Carolina Medicaid rate for CPT 11042
Healthy Connections pays $84.54 for CPT 11042 in its October 2026 fee-for-service schedule: the 19th-lowest of 45 state Medicaid programs, at 86% of the $98.39 median.
- Non-facility rate
- $84.54
- Rank
- 27 of 45
- vs. state median
- 86%
- vs. SC Medicare
- 68%
What Healthy Connections publishes for 11042
19th-lowest of 45 · 86% of median
- Schedule
- October 2026
- In effect since
- Jul 1, 2024
$67.63 to $118.36 across 5 rate types
- Pediatric Subspecialty
- $118.36
- General
- $84.54
- Podiatry
- $84.54
- Nurse Midwife
- $67.63
- PA/NP
- $67.63
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. SCDHHS Fee Schedules
11042 in neighboring states
Each state's comparable non-facility rate for 11042 in its current schedule.
| State | Rate | vs. South Carolina |
|---|---|---|
| Georgia | $62.57 | -26% |
| North Carolina | $53.26 | -37% |
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 South Carolina is $124.69; Healthy Connections's rate is 68% of that. The national amount before geographic adjustment is $132.602.
See 11042 Medicare ratesSee South Carolina's full schedule: all 8,625 codes, every published period, and commercial payer rates for 11042.
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