99417 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 99417, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 25 of the 33 states list more than one rate for 99417, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 33 states, 2 publish 99417 per 15 min and 1 per unit, and 30 schedules print no unit at all (a flat amount per service).
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 1 of the 33 states bill 99417 by time.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 99417, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 99417 run from $14.56 in Texas to $102.05 in North Carolina, a 7.0x gap in the same unit. Half the states pay more than the median of $27.52 and half pay less. The usual reasons for a spread like this in physician & professional rates:

• Modifiers such as professional or technical component, bilateral, multiple procedure and assistant at surgery change the amount paid, and states apply them with their own percentages.
• Primary-care and pediatric add-ons, enhanced rates for certain specialties and targeted increases for access problems change individual codes without moving the rest of the schedule.
• Many schedules pay differently by place of service (office versus facility) and by practitioner, and nurse practitioners and physician assistants are often paid a percentage of the physician amount.

Timing matters too. 16 states set the current rate for 99417 in 2026 or later, while 6 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For 99417, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 10 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 12 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 10 states is not classified yet.

• Plans negotiate; the published rate applies out of network (12 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (9 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Plans are expected to pay at least the published rate (1 state). Treat the published rate as a strong anchor, and confirm the minimum is written into your own plan agreement.
• State-directed payment (1 state). Eligible providers receive the directed amount on top of, or as a floor under, negotiated rates. Check whether your provider class qualifies.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example North Carolina managed care.

99417 is a CPT evaluation and management code in the physician & professional line, billed mostly by physicians, nurse practitioners, physician assistants and other licensed practitioners. Evaluation and management codes are billed once per visit. The code itself sets the level of the visit, so there is no time unit to multiply, and the setting (office, hospital, facility) decides which code applies.

Where a state publishes separate facility and non-facility amounts, the non-facility (office) amount is usually higher because the practice carries the overhead. Practitioners who are not physicians are often paid a reduced percentage of the published amount, so check the schedule for the reduction that applies to your provider type.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.