Current fee-for-service (FFS) rates published by Division of Medical Assistance and Health Services (DMAHS) for primary care codes. Medicaid-vs-Medicare rate comparison for CMS-designated E/M codes (benchmark-first launch).
FFS benchmark rates only — managed care organization (MCO) contract rates may differ. Not legal or compliance advice.
| Code | Description | Variant | Rate | Effective | Status |
|---|---|---|---|---|---|
| 99213 | Established-patient office visit, low-to-moderate complexity — one of CMS's 68 comparative-analysis codes. | — | $69.48 / visit | 2026-01-01 | Auto-extracted |
| 99214 | Office visit with moderate complexity, established patient. | — | $97.53 | 2026-01-01 | Auto-extracted |
Source: Division of Medical Assistance and Health Services (DMAHS)
No. These are fee-for-service (FFS) benchmark rates published directly by New Jersey's Medicaid agency. Managed care organizations (MCOs) negotiate their own contract rates separately, and those aren't published publicly — FFS rates are commonly used as a reference point, not a guarantee of what an MCO will pay.
It varies by state and code — some update annually, others quarterly or on an as-needed basis. MedicaidBench checks official sources continuously and logs the effective date and source document for every rate change.
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