Virginia Medicaid rate for CPT 99204
Virginia Medicaid pays a median of $127.86 across its rate types for CPT 99204 in its October 2026 fee-for-service schedule: the 20th-lowest of 45 state Medicaid programs, at 95% of the $134.20 median.
- Non-facility rate
- $127.86
- Rank
- 26 of 45
- vs. state median
- 95%
- vs. VA Medicare
- 65-74%
What Virginia Medicaid publishes for 99204
20th-lowest of 45 · 95% of median
- Schedule
- October 2026
- In effect since
- Jul 1, 2026
- Prior authorization
- Not required
$127.79 to $127.93 across 2 rate types
- Ages 21+
- $127.93
- Under 21
- $127.79
2 rate types
- Under 21
- Facility $84.23
- Ages 21+
- Facility $84.32
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. DMAS Procedure Fee Files
99204 in neighboring states
Each state's comparable non-facility rate for 99204 in its current schedule.
| State | Rate | vs. Virginia |
|---|---|---|
| Kentucky | $112.27 | -12% |
| Maryland | $174.01 | +36% |
| North Carolina | $125.39 | -2% |
| West Virginia | $122.98 | -4% |
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 Virginia is $173.60 to $197.64 across its 2 payment localities; Virginia Medicaid's rate is 65-74% of that. The national amount before geographic adjustment is $177.359.
See 99204 Medicare ratesSee Virginia's full schedule: all 8,748 codes, every published period, and commercial payer rates for 99204.
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