Texas Medicaid rate for CPT 99204
Texas Medicaid pays a median of $88.35 across its rate types for CPT 99204 in its September 2026 fee-for-service schedule: the 2nd-lowest of 45 state Medicaid programs, at 66% of the $134.20 median.
- Non-facility rate
- $88.35
- Rank
- 44 of 45
- vs. state median
- 66%
- vs. TX Medicare
- 49-52%
What Texas Medicaid publishes for 99204
2nd-lowest of 45 · 66% of median
- Schedule
- September 2026
- In effect since
- Sep 1, 2023
$81.24 to $95.47 across 4 rate types
- Medical Services · Under 21
- $95.47
- Surgery · Ages 10-20
- $95.47
- Medical Services · Ages 21+
- $81.24
- Surgery · Ages 21-55
- $81.24
4 rate types
- Medical Services · Under 21 (FP)
- $90.07
- Medical Services · Ages 10-20 (TH)
- $95.47
- Medical Services · Ages 21-55 (TH)
- $81.24
- Medical Services · Ages 21+ (FP)
- $81.24
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. TMHP Static Fee Schedules
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. Texas |
|---|---|---|
| Arkansas | $95.17 | +8% |
| Louisiana | $134.57 | +52% |
| New Mexico | $238.74 | +170% |
| Oklahoma | $156.12 | +77% |
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 Texas is $169.36 to $181.40 across its 8 payment localities; Texas Medicaid's rate is 49-52% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee Texas's full schedule: all 8,435 codes, every published period, and commercial payer rates for 99204.
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