Fee-for-service ratesAs of August 2026

Wisconsin Medicaid Fee Schedule (ForwardHealth)

ForwardHealth pays $54.39 to $60.42 for an established-patient office visit (99213), depending on the rate type. Its median across rate types, $60.42, is the 12th-lowest of 45 Medicaid programs.

Schedule as of: August 2026
Codes priced: 7,754
99213 vs. median: 85% of median

Current ForwardHealth rates for common codes

Each amount is the unmodified non-facility rate in the August 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	Across state programs
99213	Office visit, established patient (low complexity) $54.39 to $60.42 across 15 rate types Rate type FAP · Provider type 71, specialty 000 · 23 places of service $60.42 Rate type FAP · Provider type 71, specialty 000 · Telehealth $60.42 Rate type HLK · Provider type 72, specialty 000 · 27 places of service $60.42 Rate type MED · 2 provider specialties · 23 places of service $60.42 Rate type MED · 2 provider specialties · Place of service 17 $60.42 Rate type MED · 2 provider specialties · Telehealth $60.42 Rate type OTH · 2 provider specialties $60.42 Rate type OTH · 2 provider specialties · 18 places of service $60.42 Rate type PT5 · 2 provider specialties · 23 places of service $60.42 Rate type PT6 · 63 provider specialties · 23 places of service $60.42 Rate type PT6 · 63 provider specialties · Place of service 17 $60.42 Rate type PT6 · 63 provider specialties · Telehealth $60.42 Rate type PT1 · 2 provider specialties · 23 places of service $54.39 Rate type PT1 · 2 provider specialties · Place of service 17 $54.39 Rate type PT1 · 2 provider specialties · Telehealth $54.39 8 rate types Rate type FAP · Provider type 71, specialty 000 · Under 19 · 23 places of service · Payment adjustment and 61 more (AQ) $60.42 Rate type FAP · Provider type 71, specialty 000 · Under 19 · 23 places of service · Payment adjustment and 27 more (TJ) $60.42 Rate type MED · 2 provider specialties · 18 places of service and 15 more (TH) $60.42 Rate type MED · 2 provider specialties · 18 places of service · HPSA adjustment and 7 more (AQ + TH) $60.42 Rate type PT1 · 8 provider specialties · 23 places of service and 34 more (AQ) $54.39 Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 23 places of service · Payment adjustment and 15 more (TJ) $54.39 Rate type PT1 · Provider type 10, specialty 100 · 18 places of service and 5 more (TH) $54.39 Rate type PT1 · Provider type 10, specialty 100 · 18 places of service · HPSA adjustment and 2 more (AQ + TH) $54.39	$60.42Median across rate typesIn effect since Jan 1, 202412th-lowest of 45 · 85% of median	12th-lowest of 45 · 85% of median
99214	Office visit, established patient (moderate complexity) $77.00 to $85.58 across 11 rate types Rate type FAP · Provider type 71, specialty 000 · Telehealth $85.58 Rate type HLK · Provider type 72, specialty 000 · 27 places of service $85.58 Rate type MED · 2 provider specialties · 24 places of service $85.58 Rate type MED · 2 provider specialties · Telehealth $85.58 Rate type OTH · 2 provider specialties $85.58 Rate type OTH · 2 provider specialties · 22 places of service $85.58 Rate type PT5 · 2 provider specialties · 24 places of service $85.58 Rate type PT6 · 63 provider specialties · 24 places of service $85.58 Rate type PT6 · 63 provider specialties · Telehealth $85.58 Rate type PT1 · 2 provider specialties · 24 places of service $77.00 Rate type PT1 · 2 provider specialties · Telehealth $77.00 4 rate types Rate type FAP · Provider type 71, specialty 000 · Under 19 · Telehealth · Payment adjustment and 44 more (AQ) $85.58 Rate type FAP · Provider type 71, specialty 000 · Under 19 · Telehealth · Payment adjustment and 15 more (TJ) $85.58 Rate type PT1 · 7 provider specialties · 24 places of service and 21 more (AQ) $77.00 Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 24 places of service · Payment adjustment and 7 more (TJ) $77.00	$85.58Median across rate typesIn effect since Jan 1, 202412th-lowest of 45 · 84% of median	12th-lowest of 45 · 84% of median
99203	Office visit, new patient (low complexity) $66.93 to $74.38 across 13 rate types Rate type FAP · Provider type 71, specialty 000 · Telehealth $74.38 Rate type MED · 2 provider specialties · 23 places of service $74.38 Rate type MED · 2 provider specialties · Place of service 17 $74.38 Rate type MED · 2 provider specialties · Telehealth $74.38 Rate type OTH · 2 provider specialties $74.38 Rate type OTH · 2 provider specialties · 27 places of service $74.38 Rate type PT5 · 2 provider specialties · 23 places of service $74.38 Rate type PT6 · 63 provider specialties · 23 places of service $74.38 Rate type PT6 · 63 provider specialties · Place of service 17 $74.38 Rate type PT6 · 63 provider specialties · Telehealth $74.38 Rate type PT1 · 2 provider specialties · 23 places of service $66.93 Rate type PT1 · 2 provider specialties · Place of service 17 $66.93 Rate type PT1 · 2 provider specialties · Telehealth $66.93 4 rate types Rate type FAP · Provider type 71, specialty 000 · Under 19 · Telehealth · Payment adjustment and 55 more (AQ) $74.38 Rate type FAP · Provider type 71, specialty 000 · Under 19 · Telehealth · Payment adjustment and 19 more (TJ) $74.38 Rate type PT1 · 7 provider specialties · 23 places of service and 27 more (AQ) $66.93 Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 23 places of service · Payment adjustment and 11 more (TJ) $66.93	$74.38Median across rate typesIn effect since Jan 1, 20248th-lowest of 45 · 83% of median	8th-lowest of 45 · 83% of median
99204	Office visit, new patient (moderate complexity) $99.86 to $110.94 across 10 rate types Rate type FAP · Provider type 71, specialty 000 · Telehealth $110.94 Rate type MED · 2 provider specialties · 24 places of service $110.94 Rate type MED · 2 provider specialties · Telehealth $110.94 Rate type OTH · 2 provider specialties $110.94 Rate type OTH · 2 provider specialties · 18 places of service $110.94 Rate type PT5 · 2 provider specialties · 24 places of service $110.94 Rate type PT6 · 63 provider specialties · 24 places of service $110.94 Rate type PT6 · 63 provider specialties · Telehealth $110.94 Rate type PT1 · 2 provider specialties · 24 places of service $99.86 Rate type PT1 · 2 provider specialties · Telehealth $99.86 8 rate types Rate type FAP · Provider type 71, specialty 000 · Under 19 · Telehealth · Payment adjustment and 48 more (AQ) $110.94 Rate type FAP · Provider type 71, specialty 000 · Under 19 · Telehealth · Payment adjustment and 23 more (TJ) $110.94 Rate type MED · 2 provider specialties · 19 places of service and 11 more (TH) $110.94 Rate type MED · 2 provider specialties · 19 places of service · HPSA adjustment and 5 more (AQ + TH) $110.94 Rate type PT1 · 7 provider specialties · 24 places of service and 24 more (AQ) $99.86 Rate type PT1 · Provider type 10, specialty 100 · Under 19 · 24 places of service · Payment adjustment and 11 more (TJ) $99.86 Rate type PT1 · Provider type 10, specialty 100 · 19 places of service and 3 more (TH) $99.86 Rate type PT1 · Provider type 10, specialty 100 · 19 places of service · HPSA adjustment and 1 more (AQ + TH) $99.86	$110.94Median across rate typesIn effect since Jan 1, 20249th-lowest of 45 · 83% of median	9th-lowest of 45 · 83% of median
99285	Emergency department visit, high severity with threat to function $59.56 to $66.18 across 2 rate types Rate type MED · 5 provider specialties · 7 places of service $66.18 Rate type PT1 · 2 provider specialties · 7 places of service $59.56 4 rate types Rate type MED · 6 provider specialties · Under 19 · 7 places of service · Payment adjustment and 1 more (TJ) $66.18 Rate type MED · 17 provider specialties · Under 19 · 7 places of service · HPSA adjustment and 7 more (AQ) $66.18 Rate type PT1 · 2 provider specialties · Ages 19+ · 7 places of service and 4 more (AQ) $59.56 Rate type PT1 · 2 provider specialties · Ages 19+ · 7 places of service and 1 more (TJ) $59.56	$62.87Median across rate typesIn effect since Jan 1, 2024Lowest of 42 · 45% of median	Lowest of 42 · 45% of median

Dot: Wisconsin. Tick: median across state programs. Line: lowest to highest state. Base fee-for-service rates; supplemental payments some states add are not included.

Wisconsin's median is 12th-lowest of 45 for 99213. See where all 7,754 ForwardHealth codes rank.

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