South Carolina Medicaid rate for CPT 99204
Healthy Connections pays $122.26 for CPT 99204 in its October 2026 fee-for-service schedule: the 16th-lowest of 45 state Medicaid programs, at 91% of the $134.20 median.
- Non-facility rate
- $122.26
- Rank
- 30 of 45
- vs. state median
- 91%
- vs. SC Medicare
- 72%
What Healthy Connections publishes for 99204
16th-lowest of 45 · 91% of median
- Schedule
- October 2026
- In effect since
- Jul 1, 2024
$97.81 to $171.16 across 6 rate types
- Pediatric Subspecialty
- $171.16
- Enhanced
- $157.71
- General
- $122.26
- Podiatry
- $122.26
- Nurse Midwife
- $97.81
- PA/NP
- $97.81
13 rate types
- Enhanced (FP)
- $157.71
- Enhanced (GT)
- $157.71
- Enhanced (P4)
- $158.14
- General (FP)
- $122.26
- General and 1 more (GT)
- $122.26
- General (P4)
- $122.59
- Nurse Midwife and 1 more (FP)
- $97.81
- Nurse Midwife and 1 more (GT)
- $97.81
- Nurse Midwife (SB)
- $98.07
- PA/NP (P4)
- $98.07
- Pediatric Subspecialty (FP)
- $171.16
- Pediatric Subspecialty (GT)
- $171.16
- Pediatric Subspecialty (P4)
- $171.63
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
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. South Carolina |
|---|---|---|
| Georgia | $110.51 | -10% |
| North Carolina | $125.39 | +3% |
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 South Carolina is $169.89; Healthy Connections's rate is 72% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee South Carolina's full schedule: all 8,625 codes, every published period, and commercial payer rates for 99204.
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