Vermont Medicaid rate for CPT 99204
Vermont Medicaid pays a median of $194.21 across its rate types for CPT 99204 in its October 2026 fee-for-service schedule: the 5th-highest of 45 state Medicaid programs, at 145% of the $134.20 median.
- Non-facility rate
- $194.21
- Rank
- 5 of 45
- vs. state median
- 145%
- vs. VT Medicare
- 113%
What Vermont Medicaid publishes for 99204
5th-highest of 45 · 145% of median
- Schedule
- October 2026
- In effect since
- Jul 1, 2026
- Prior authorization
- Not required
$146.88 to $241.54 across 2 rate types
- Provider type 037 · Specialty S12 · PAC 3
- $241.54
- Provider type 000 · Specialty 000 · PAC R
- $146.88
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. Vermont Medicaid Fee Schedule Lookup
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. Vermont |
|---|---|---|
| Massachusetts | $128.18 | -34% |
| New Hampshire | $69.90 | -64% |
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 Vermont is $172.57; Vermont Medicaid's rate is 113% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee Vermont's full schedule: all 11,875 codes, every published period, and commercial payer rates for 99204.
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