99204 Medicaid reimbursement rates by state
New-patient office visit, level 3 of 4. 29 state Medicaid programs publish a fee-for-service rate for 99204 at the physician psychologist level. Rates run from $36.36 in New York to $924.87 in California, with a median of $125.39.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 29
- Median rate
- $125.39units vary by state
- Highest
- $924.87California
- Medicare (non-facility)
- $163.57–$219.662026 physician fee schedule
99204 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| CaliforniaPhysician or licensed psychologist (incl. BCBA-D) · California Medi-Cal Specialty Mental Health Services (DHCS fee schedule for county Mental Health Plans) | $924.87⚠ over 3× mediansince 2026-07-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Behavioral Health Fee Schedules |
| OhioAgency provider · Ohio Medicaid (fee-for-service) | $207.36since 2024-01-01 | encounter | — | Plans expected to pay at least this | 122% | OAC 5160-27-03 Appendix A, Community Beh |
| MissouriPhysician or licensed psychologist (incl. BCBA-D) · Missouri MO HealthNet (fee-for-service) | $201.59since 2022-07-01 | — | — | Paid by the state, outside plans | — | MO HealthNet fee schedule: Community Psy |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $197.44since 2023-07-01 | — | — | Plans must pay at least this | — | NJMMIS Procedure Master Listing CPTHCPCS |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $182.89since 2024-07-01 | — | — | Not classified | — | CMAP fee schedule: Clinic and Outpatient |
| MarylandPhysician or licensed psychologist (incl. BCBA-D) · Maryland Public Behavioral Health System (specialty mental health, SUD and ABA, paid fee-for-service through the Carelon ASO) | $174.01since 2026-03-01 | visit | — | Paid by the state, outside plans | — | FY2027 PBHS Fee Schedule – SUD_7.6.2026 |
| MassachusettsPhysician or licensed psychologist (incl. BCBA-D) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $169.28since 2025-09-01 | — | — | Plans must pay at least this | — | Rates for Mental Health Services Provide |
| GeorgiaPhysician or licensed psychologist (incl. BCBA-D) · Georgia Medicaid (fee-for-service) | $167.09since 2021-07-01 | — | — | Plans negotiate; applies out of network | — | Max Allow Pymt Physician Enhanced Rate C |
| AlabamaPhysician or licensed psychologist (incl. BCBA-D) · Alabama Coordinated Health Network (primary care case management entities; payments made fee-for-service by the Alabama Medicaid Agency) | $166.00since 2024-10-01 | — | — | Not classified | — | Provider Insider October 2025, 'ACHN Par |
| MichiganPhysician or licensed psychologist (incl. BCBA-D) · Michigan Medicaid (fee-for-service) | $156.08since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Physician Primary Care Rate Increa |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $141.95since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $136.71since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| LouisianaPhysician or licensed psychologist (incl. BCBA-D) · Louisiana Medicaid (fee-for-service) | $134.57since 2025-07-01 | — | — | Plans must pay at least this | — | Specialized Behavioral Health Services f |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $134.20since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $125.39since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Clinical Pharm |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $122.26since 2024-07-01 | — | — | Not classified | — | SCDHHS Base Physician Fee Schedule (sche |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $122.16since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| NebraskaPhysician or licensed psychologist (incl. BCBA-D) · Nebraska Medicaid (fee-for-service) | $118.06since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid Mental Health and Subs |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $117.82since 2024-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $117.28since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Medication for opioid use disorder f |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $116.53since 2020-01-01 | encounter | — | Plans negotiate; applies out of network | — | DMS CMHC Mental Health Substance Abuse f |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $110.94since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| ArizonaPhysician or licensed psychologist (incl. BCBA-D) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $98.62since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $91.68since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Practitioner Fee Schedule (2026-01-01) |
| IllinoisPhysician or licensed psychologist (incl. BCBA-D) · Illinois Medicaid (HFS fee-for-service) | $90.81since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | CY 2025 Access Rule Comparative Analysis |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $90.37since 2021-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $84.32since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $81.24since 2021-11-17 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| New YorkPhysician or licensed psychologist (incl. BCBA-D) · New York Medicaid HIV Enhanced Fees for Physicians Program | $36.36since 2022-04-01 | unit | — | Not classified | — | eMedNY Physician Enhanced Program Fee Sc |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 99204?
It depends on the state. Of the 29 states with a published fee-for-service rate, the median is $125.39. California pays the most ($924.87) and New York the least ($36.36 per unit).
Which state pays the highest Medicaid rate for 99204?
California, at $924.87, effective 2026-07-01.
How do Medicaid rates for 99204 compare with Medicare?
Where the billing units match, Medicaid pays between 122% and 122% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 99204?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
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Track 99204 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.