A medical bill in New York usually starts at the provider’s list price, the number almost nobody pays. Insurers pay negotiated rates that are mostly confidential. Medicaid’s rates are the exception: the state publishes them, service by service, in fee schedules that anyone can download from eMedNY, the state’s Medicaid billing system. They are written for billing offices, in spreadsheets with truncated descriptions and five-digit codes. We turned the most common ones into plain English.
Office and emergency visits
Each visit is billed with a code for its level. The office column is what Medicaid pays when the visit happens in a doctor’s office or clinic; the facility column is the physician’s fee when the same visit takes place in a hospital or other facility, which bills its own charge on top.
| Visit | Code | Office | Facility |
|---|---|---|---|
| Preventive visit, new patient, 18 to 39 | 99385 | $113.55 | $37.20 |
| Preventive visit, established patient, 18 to 39 | 99395 | $104.28 | $33.05 |
| Emergency department, low complexity (physician) | 99283 | $65.90 | |
| Emergency department, moderate complexity (physician) | 99284 | $112.50 | |
| Emergency department, high complexity (physician) | 99285 | $163.13 | |
| Electrocardiogram with interpretation | 93000 | $15.15 | $15.15 |
The emergency department codes are the physician’s part of an ER visit only. The hospital’s facility charge for the same visit is separate and usually much larger. What an ER visit costs.
Imaging
An imaging bill has two parts: the technical part (the machine and the staff) and the professional part (the radiologist’s reading). Medicaid lists the radiologist’s part separately: $61.94 for a brain MRI without contrast, $76.04 for a CT of the abdomen and pelvis with contrast, $9.16 for a chest X-ray. When a scan is done in a hospital, the radiologist’s bill and the hospital’s bill arrive separately. Why one scan produces two bills.
Procedures, therapy, eye care and childbirth
| Service | Code | Office | Facility |
|---|---|---|---|
| Colonoscopy, diagnostic | 45378 | $314.66 | $103.24 |
| Colonoscopy with biopsy | 45380 | $405.33 | $161.60 |
| Psychiatric diagnostic evaluation | 90791 | $177.67 | $60.38 |
| Psychotherapy, 45 minutes | 90834 | $110.09 | $37.79 |
| Psychotherapy, 60 minutes | 90837 | $161.13 | $57.05 |
| Eye exam, new patient, comprehensive | 92004 | $131.12 | $44.80 |
| Eye exam, established patient, comprehensive | 92014 | $111.18 | $34.48 |
| Stitches, simple repair up to 2.5 cm | 12001 | $86.39 | $47.82 |
| Stitches, simple repair 2.6 to 7.5 cm | 12002 | $103.93 | $53.61 |
| Joint injection or aspiration, major joint | 20610 | $58.82 | $24.23 |
| Complete blood count | 85025 | $3.20 | |
| Vaginal delivery only | 59409 | $771.62 | $771.62 |
| Vaginal delivery with prenatal and postpartum care | 59400 | $2,238.52 | $1,737.96 |
| Cesarean delivery with prenatal and postpartum care | 59510 | $2,486.34 | $1,967.57 |
Source: eMedNY physician fee schedules, Medicine and Surgery effective July 1, 2026. The childbirth codes are the physician’s global fee; the hospital stay is billed separately.
How to use these numbers on a bill
The fee schedule is a reference, not a price you are owed. It helps in three situations.
| Your situation | What the Medicaid fee does for you |
|---|---|
| Uninsured, hospital bill, income up to 400% of the poverty level | The law caps the charge at a share of the Medicaid rate. Apply for financial assistance and ask the hospital, in writing, which Medicaid rate it used |
| A bill from a doctor’s office or physician group | No legal cap, but the Medicaid fee is an official benchmark to anchor an offer. Negotiating in the right order |
| Paying cash before planned care | Ask for a written good faith estimate and compare it with the Medicaid fee and the hospital’s price file |
What to say: “Before I pay, I’d like the billing codes for each line. The Medicaid fee for code 99214 is $121.96. I can pay a fixed amount within 30 days if the account is closed as paid in full.”
The codes on your itemized bill are what connect it to this table. If a line has no code, ask for one. What a CPT code is and how to read an itemized bill.
Where these numbers stop
Hospital facility charges are not here. New York Medicaid pays hospitals for their own share of outpatient and inpatient care under separate methods, not under the physician fee schedule. For a hospital bill, the number that matters is the hospital’s Medicaid rate for your visit, which you can request in writing.
Some services sit in other schedules. Most laboratory tests, physical therapy and dental care have their own fee schedules, so they are not in this table. The one lab fee shown, a complete blood count, is in the physician schedule.
Medicaid managed care plans pay doctors under their own contracts, which may differ from these fee-for-service rates.
Methodology and data
We downloaded the New York State Medicaid physician fee schedules from eMedNY on October 10, 2026: Medicine and Surgery effective July 1, 2026, Radiology effective October 1, 2026. eMedNY describes each fee as the maximum reimbursable Medicaid fee. We selected 38 common services and wrote plain-language descriptions from the official code descriptions. Amounts are rounded to the cent.
Download: ny-medicaid-fees-2026-common-services.csv, one row per code, free to reuse under CC BY 4.0. Credit: NYC Med News, “What New York Medicaid Pays for 38 Common Services in 2026,” from eMedNY data.
Questions people ask
How much does New York Medicaid pay for a doctor visit in 2026?
For a typical follow-up office visit (CPT 99213), $86.75. A new patient visit of low complexity (99203) pays $106.47, and a longer follow-up (99214) $121.96, according to the eMedNY fee schedule effective July 1, 2026.
How much does Medicaid pay for an MRI in New York?
$334.43 for a brain MRI without contrast and $514.84 without and with contrast, in an office or imaging center. The radiologist’s reading alone is $61.94 for the first and $95.21 for the second.
Where can I find the New York Medicaid fee schedule?
On eMedNY, the state’s Medicaid billing site, in the provider manual for each type of provider. Physician fees are published as spreadsheets by section: medicine, surgery, radiology and drugs.
Why does the Medicaid rate matter if I’m not on Medicaid?
New York’s hospital financial assistance law caps what uninsured patients can be charged as a share of the Medicaid rate, and the rate is a public benchmark for negotiating any bill.
Is the Medicaid rate what a hospital can charge me?
Not exactly. Between 200% and 400% of the poverty level the hospital’s charge is capped at 10% or 20% of its Medicaid rate, and at or below 200% it is $0. The hospital’s own facility rate is not in the physician fee schedule; ask the hospital for it in writing.
Sources
- eMedNY — New York State Medicaid physician manual and fee schedules (Medicine and Surgery effective July 1, 2026; Radiology effective October 1, 2026) (checked 2026-10-10)
- eMedNY — fee schedule column descriptions (checked 2026-10-10)
- New York State Attorney General — Hospital financial assistance (checked 2026-10-07)
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This page explains how the system works. It is not medical advice. More.