Virginia Medicaid rate for CPT 99213
Virginia Medicaid pays a median of $68.63 across its rate types for CPT 99213 in its October 2026 fee-for-service schedule: the 21st-lowest of 45 state Medicaid programs, at 97% of the $71.05 median.
- Non-facility rate
- $68.63
- Rank
- 25 of 45
- vs. state median
- 97%
- vs. VA Medicare
- 64-73%
What Virginia Medicaid publishes for 99213
21st-lowest of 45 · 97% of median
- Schedule
- October 2026
- In effect since
- Jul 1, 2026
- Prior authorization
- Not required
$68.59 to $68.66 across 2 rate types
- Ages 21+
- $68.66
- Under 21
- $68.59
2 rate types
- Under 21
- Facility $41.39
- Ages 21+
- Facility $41.44
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
99213 in neighboring states
Each state's comparable non-facility rate for 99213 in its current schedule.
| State | Rate | vs. Virginia |
|---|---|---|
| Kentucky | $42.63 | -38% |
| Maryland | $94.62 | +38% |
| North Carolina | $54.26 | -21% |
| West Virginia | $65.15 | -5% |
99213 in every state
Map and ranking of every state program that prices 99213.
Compare 99213 across states99213 under Medicare
Medicare's 2026 non-facility payment for 99213 in Virginia is $93.48 to $106.56 across its 2 payment localities; Virginia Medicaid's rate is 64-73% of that. The national amount before geographic adjustment is $95.193.
See 99213 Medicare ratesSee Virginia's full schedule: all 8,748 codes, every published period, and commercial payer rates for 99213.
Book a 15-min Medicaid walkthrough