Vermont Medicaid Fee Schedule
Vermont Medicaid pays $60.72 to $79.37 for an established-patient office visit (99213), depending on the rate type. Its median across rate types, $79.37, is the 15th-highest of 45 Medicaid programs.
- Schedule as of
- October 2026
- Codes priced
- 11,875
- 99213 vs. median
- 112% of median
Current Vermont Medicaid rates for common codes
Each amount is the unmodified non-facility rate in the October 2026 schedule. Where a code appears under more than one rate type, it is the state's ordinary statewide rate when its rules name one, and otherwise the median across rate types. Modifier-specific and facility-only rows are listed separately under the service.
| Code | Service | Non-facility rate | Prior auth |
|---|---|---|---|
| 99213 | Office visit, established patient (low complexity)$60.72 to $79.37 across 4 rate types
| $79.37Median across rate typesIn effect since Jul 1, 202615th-highest of 45 · 112% of median | Not required |
| 99214 | Office visit, established patient (moderate complexity)$93.74 to $112.91 across 4 rate types
| $112.91Median across rate typesIn effect since Jul 1, 202615th-highest of 45 · 111% of median | Not required |
| 99203 | Office visit, new patient (low complexity)$97.36 to $141.17 across 2 rate types
| $119.26Median across rate typesIn effect since Jul 1, 20268th-highest of 45 · 133% of median | Not required |
| 99204 | Office visit, new patient (moderate complexity)$146.88 to $241.54 across 2 rate types
| $194.21Median across rate typesIn effect since Jul 1, 20265th-highest of 45 · 145% of median | Not required |
| 99285 | Emergency department visit, high severity with threat to function | $138.38In effect since Jan 1, 202620th-lowest of 42 · 100% of median | Not required |
Dot: Vermont. Tick: median across state programs. Line: lowest to highest state. Base fee-for-service rates; supplemental payments some states add are not included.
Vermont's median is 15th-highest of 45 for 99213. See where all 11,875 Vermont Medicaid codes rank.
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Compare any other code across state programs. The free view shows a few states per code; Vermont's full schedule is in the complete dataset.
Neighboring and high-enrollment Medicaid fee schedules
States bordering Vermont first, then the largest programs.