The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for 99243. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
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Publishing states
34
Median % of Medicare
--
Rate range
$42.57 - $200.98
99243 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alaska | $200.98 | -- | -- | 2026 |
| Alabama | $86.00 | -- | -- | 2026 |
| Arkansas | $109.45 | -- | -- | 2026 |
| Arizona | $107.93 | -- | -- | 2022 |
| California | $103.09 | -- | -- | 2026 |
| Connecticut | $88.26 | -- | Required | 2012 |
| District of Columbia | $99.92 | -- | Not required | 2026 |
| Florida | $68.06 | -- | -- | 2026 |
| Georgia | $100.50 | -- | -- | 2026 |
| Iowa | $42.57 | -- | -- | 2020 |
| Illinois | $49.91 | -- | -- | 2009 |
| Kentucky | $90.43 | -- | -- | 2026 |
| Massachusetts | $85.38 | -- | -- | 2026 |
| Michigan | $55.81 | -- | -- | 2026 |
| Minnesota | $87.37 | -- | -- | 2026 |
| Mississippi | $104.82 | -- | -- | 2026 |
| North Carolina | $99.91 | -- | -- | 2025 |
| Nebraska | $120.64 | -- | -- | 2026 |
| New Jersey | $105.38 | -- | Not required | 2026 |
| New Mexico | $159.85 | -- | -- | 2025 |
| Nevada | $129.00 | -- | -- | 2024 |
| New York | $48.30 | -- | -- | 2026 |
| Ohio | $60.74 | -- | -- | 2024 |
| Pennsylvania | $69.46 | -- | -- | 2025 |
| Rhode Island | $131.88 | -- | -- | 2026 |
| South Carolina | $82.32 | -- | -- | 2024 |
| Texas | $81.87* | -- | -- | 2016 |
| Utah | $85.77* | -- | Not required | 2026 |
| Virginia | $81.19* | -- | -- | 2026 |
| Vermont | $177.58 | -- | -- | 2026 |
| Washington | $67.65 | -- | -- | 2026 |
| Wisconsin | $84.56 | -- | -- | 2020 |
| West Virginia | $77.84 | -- | -- | 2026 |
| Wyoming | $124.71 | -- | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related physician codes
- 10021 - Fine needle aspiration biopsy, first lesion, no imaging
- 10060 - Drainage of a skin abscess, simple
- 10061 - Drainage of a skin abscess, complicated or multiple
- 10120 - Removal of a foreign body from tissue, simple
- 10140 - Drainage of a blood or fluid collection under the skin
- 11042 - Wound debridement, skin and tissue below, first 20 sq cm
- 11043 - Wound debridement to muscle, first 20 sq cm
- 11044 - Wound debridement to bone, first 20 sq cm
Frequently asked questions
How much does Medicaid pay for 99243?
34 state Medicaid programs publish a fee-for-service rate for 99243 (office consultation, low complexity), ranging from $42.57 in Iowa to $200.98 in Alaska. The full table on this page lists every publishing state's current rate.
Which state pays the most for 99243?
Alaska publishes the highest Medicaid rate for 99243 at $200.98. Iowa publishes the lowest at $42.57.
Does 99243 require prior authorization under Medicaid?
1 of the 34 publishing states flag 99243 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".