Fee-for-service rateAs of October 2026

South Carolina Medicaid rate for CPT 99213

Office visit, established patient (low complexity)

Healthy Connections pays $69.94 for CPT 99213 in its October 2026 fee-for-service schedule: the 22nd-lowest of 45 state Medicaid programs, at 98% of the $71.05 median.

Non-facility rate: $69.94
Rank: 24 of 45
vs. state median: 98%
vs. SC Medicare: 77%

What Healthy Connections publishes for 99213

22nd-lowest of 45 · 98% of median

Schedule: October 2026
In effect since: Jul 1, 2024

$55.95 to $97.91 across 6 rate types

Pediatric Subspecialty: $97.91
Enhanced: $90.22
General: $69.94
Podiatry: $69.94
Nurse Midwife: $55.95
PA/NP: $55.95

18 rate types

Enhanced (FP): $90.22
Enhanced (GT): $90.22
Enhanced (P4): $90.22
Enhanced (TH): $90.22
General (FP): $69.94
General and 1 more (GT): $69.94
General (P4): $69.94
General (TH): $69.94
Nurse Midwife and 1 more (FP): $55.95
Nurse Midwife and 1 more (GT): $55.95
Nurse Midwife (SB): $46.49
Nurse Midwife (TH): $46.49
PA/NP (P4): $55.95
PA/NP (TH): $55.95
Pediatric Subspecialty (FP): $97.91
Pediatric Subspecialty (GT): $97.91
Pediatric Subspecialty (P4): $97.91
Pediatric Subspecialty (TH): $97.91

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

99213 in neighboring states

Each state's comparable non-facility rate for 99213 in its current schedule.

State	Rate	vs. South Carolina
Georgia	$82.05	+17%
North Carolina	$54.26	-22%

99213 in every state

Map and ranking of every state program that prices 99213.

Compare 99213 across states

99213 under Medicare

Medicare's 2026 non-facility payment for 99213 in South Carolina is $91.04; Healthy Connections's rate is 77% of that. The national amount before geographic adjustment is $95.193.

See 99213 Medicare rates

See South Carolina's full schedule: all 8,625 codes, every published period, and commercial payer rates for 99213.

Book a 15-min Medicaid walkthrough

Other Healthy Connections rates

99214$98.84 99203$81.29 99204$122.26 99283$52.35 99284$89.10 99285$129.13 93000$9.43 93306$127.81 96372$3.72 20610$42.91 11042$84.54 12001$61.63 29881$361.35 45378$221.97 47562$438.15 64483$160.53 66984$356.26 90834$70.42 90837$103.83