Virginia Medicaid Fee Schedule
Virginia Medicaid pays $68.59 to $68.66 for an established-patient office visit (99213), depending on the rate type. Its median across rate types, $68.63, is the 21st-lowest of 45 Medicaid programs.
- Schedule as of
- October 2026
- Codes priced
- 8,748
- 99213 vs. median
- 97% of median
Current Virginia 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)$68.59 to $68.66 across 2 rate types
2 rate types
| $68.63Median across rate typesIn effect since Jul 1, 202621st-lowest of 45 · 97% of median | Not required |
| 99214 | Office visit, established patient (moderate complexity)$97.71 to $97.81 across 2 rate types
2 rate types
| $97.76Median across rate typesIn effect since Jul 1, 202621st-lowest of 45 · 96% of median | Not required |
| 99203 | Office visit, new patient (low complexity)$84.71 to $84.80 across 2 rate types
2 rate types
| $84.76Median across rate typesIn effect since Jul 1, 202622nd-lowest of 45 · 95% of median | Not required |
| 99204 | Office visit, new patient (moderate complexity)$127.79 to $127.93 across 2 rate types
2 rate types
| $127.86Median across rate typesIn effect since Jul 1, 202620th-lowest of 45 · 95% of median | Not required |
| 99285 | Emergency department visit, high severity with threat to function | $119.82In effect since Jul 1, 202611th-lowest of 42 · 86% of median | Not required |
Dot: Virginia. Tick: median across state programs. Line: lowest to highest state. Base fee-for-service rates; supplemental payments some states add are not included.
Virginia's median is 21st-lowest of 45 for 99213. See where all 8,748 Virginia Medicaid codes rank.
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Compare any other code across state programs. The free view shows a few states per code; Virginia's full schedule is in the complete dataset.
Neighboring and high-enrollment Medicaid fee schedules
States bordering Virginia first, then the largest programs.