Physician Assistant Reimbursement Rates by State: What Market Data Reveals About the PA Pay Gap

We analyzed millions of negotiated rate records across four states to test whether commercial payers reimburse PA visits at higher rates in high-salary states. The findings challenge a common assumption.

When Becker's Hospital Review published the National Commission on Certification of Physician Assistants' 2024 state-by-state income data in April 2026, one pattern stood out immediately: median PA compensation varies by as much as $30,000 depending on where you practice. California and Nevada top the list at $145,000. Pennsylvania, Ohio, and 15 other states sit at the bottom tier at $115,000.

The natural follow-on question, especially for payers, providers, and self-funded employers making workforce decisions, is whether commercial payers actually reimburse more for PA visits in high-salary states. Or is the compensation gap absorbed entirely by cost of living, labor market pressures, and practice economics?

We used Gigasheet to find out.

The Hypothesis: Payer Rates and PA Salaries Don't Move Together

Our working hypothesis was that they don't, that payer reimbursement rates are driven primarily by local market structure, payer concentration, and network leverage, not by the labor cost environment. Price transparency data gives us a direct way to test that.

If payer rates track with PA salaries, you'd expect to see materially higher negotiated rates for the same E/M code in California than in Pennsylvania, roughly proportional to the $30,000 salary gap. If they don't, you'd expect rates to look similar across tiers regardless of what PAs earn in a given market.

Methodology

We queried payer published price transparency data under the federal price transparency rule and available in Gigasheet. We selected one state from each NCCPA compensation tier: Pennsylvania (Tier 4, $115k), Texas (Tier 3, $125k), Massachusetts (Tier 2, $135k), and California (Tier 1, $145k). In states where payer data is published in separate files, we assembled results across multiple payer MRFs and combined them in Gigasheet.

What Commercial Payers Actually Pay for PA Office Visits

The headline finding: California and Pennsylvania have nearly identical median reimbursement rates for a 99213 visit, $65 and $64, respectively, despite California PAs earning $30,000 more per year.

Texas comes in modestly higher at $69, roughly proportional to its $10,000 salary premium over Pennsylvania. Massachusetts is the outlier at $87, but as we'll explain, that figure requires significant context.

State-by-State Breakdown

Pennsylvania, The Baseline ($115,000 Median PA Salary)

Pennsylvania's market-wide median negotiated rate for a 99213 visit is approximately $64. That figure masks a significant internal split: negotiated-type contracts carry a median of $74, while fee-schedule contracts, representing roughly 25% of qualifying volume and dominated by Aetna, carry a median of just $32. The combined market median sits below Medicare's reference rate of approximately $86 for the same code.

For context, Medicare pays PAs at 85% of the physician fee schedule for direct billing. The Pennsylvania commercial median falls below even that floor on a market-wide basis, a meaningful indicator of the state's payer leverage environment and the pricing pressure PA-heavy practices face.

Texas, A Modest Premium ($125,000 Median PA Salary)

Texas shows a combined 99213 median of approximately $69, about $5 above Pennsylvania. The $10,000 salary gap between Texas and Pennsylvania PAs implies, at roughly 1,500 visits per year, that you'd need about $6–7 more per 99213 visit to break even on the salary premium. The rate data lands right in that range, but just barely.

Texas also surfaces a structural contrast: fee schedule rates ($73 median for 99213) actually exceed negotiated rates ($62 median), the opposite of the Pennsylvania pattern. The modest Texas premium appears to reflect how BCBS Texas and Cigna structure their contracts in this market rather than a broad market-level lift in reimbursement.

Massachusetts, The Outlier ($135,000 Median PA Salary)

Massachusetts posts the highest combined median in our analysis, approximately $87 for 99213 and $128 for 99214, but the story behind those numbers matters as much as the numbers themselves.

The Massachusetts market is effectively split in two. Harvard Pilgrim Health Care and Cigna form a distinct high-paying tier: Harvard Pilgrim's 99213 rates run $151–$173 depending on contract type; Cigna's fee schedule median lands at $136. Aetna, Tufts Health Plan, and Meritain cluster between $78 and $88. The gap between tiers, $50 to $85 per visit on the same code in the same state, is larger than the rate gap between Pennsylvania and California across the entire country.

Remove Harvard Pilgrim and Cigna from the Massachusetts calculation and the combined median falls to approximately $80, barely above Texas. The Massachusetts PA salary advantage is real, but it is a Harvard Pilgrim and Cigna story, not a market-wide one. A PA practice contracted primarily with Aetna or Tufts in Boston faces economics closer to Texas than the salary benchmarks suggest.

California, The Central Finding ($145,000 Median PA Salary)

California's combined 99213 median is approximately $65, statistically indistinguishable from Pennsylvania's $64.

BCBS/Anthem dominates California PA professional billing volume at approximately 77% of qualifying rates, contracting exclusively via fee schedule at a median of $63.84 for 99213. Aetna follows its national pattern, with negotiated rates around $71 and fee schedule rates around $32. The highest-salary PA market in the country is being reimbursed at the same market-wide median as the lowest-salary tier.

What This Means for Providers, Payers, and Self-Funded Employers

For Providers and Practice Administrators

PA compensation decisions are typically benchmarked against salary surveys. Revenue decisions are made by payer contracts. These two numbers don't move together.

A practice in California contracting primarily with BCBS/Anthem and Aetna collects approximately $65 per 99213 visit while paying $145,000 in median PA salary. A comparable practice in Pennsylvania collecting $64 per visit pays $115,000. The per-visit revenue is nearly identical; the labor cost is $30,000 higher. Knowing your payer rate distribution, not just your salary benchmarks, is essential to understanding practice margin in PA-heavy specialties.

For Self-Funded Employers

The Massachusetts data surfaces something worth examining for self-funded plan sponsors. Meritain Health, which uses Aetna's network and acts as a TPA for self-funded employers, shows fee schedule rates of $55 for 99213, notably higher than Aetna's own commercial fee schedule rate of $36 for the same code in the same state. On the negotiated side, the rates are nearly identical.

The implication: self-funded employers using a carrier-affiliated TPA are not automatically getting the carrier's commercial rates. The fee schedule tier can differ materially, and in this case employers are paying providers more, not less, than the carrier's own commercial book rate on that contract type. Plan sponsors should confirm which fee schedule applies to their specific plan arrangement.

For Payers

The rate disparity within a single state exceeds the disparity across the country. The gap between Harvard Pilgrim and Aetna in Massachusetts ($151 vs. $87 on 99213 negotiated) is larger than the gap between the highest and lowest salary states in our sample ($87 in Massachusetts vs. $64 in Pennsylvania at the combined level). PA reimbursement strategy is a market-by-market, payer-by-payer decision, and that variation is now visible in the MRF data to anyone willing to look.

How We Did This Analysis

This type of cross-market, multi-payer rate comparison was not feasible before the federal price transparency rule required payers to publish machine-readable in-network rate files. Even with those files publicly available, the data volumes are significant, billions of rows across dozens of payer MRFs per state.

We used Gigasheet to query, filter, and analyze MRF data across multiple states and payers, applying taxonomy, billing class, and rate type filters to isolate PA-specific professional E/M rates. Gigasheet's ability to run analytical queries against files at this scale, without data engineering or infrastructure overhead, is what made the analysis practical in the first place.

If you're a payer, provider organization, or self-funded employer that wants to explore your own rate positioning against this data, Gigasheet can help you query payer published data, compare negotiated rates, and turn raw information into market intelligence.

Frequently Asked Questions

Do payer reimbursement rates for physician assistants vary by state? Yes, but not as dramatically as PA salaries do. Our analysis found that combined market medians for a 99213 visit range from approximately $64 in Pennsylvania to $87 in Massachusetts. Median PA salaries across those same states span from $115,000 to $135,000. The rate variation is real but does not consistently track with salary variation, and California, the highest-salary state in our sample, shows rates nearly identical to the lowest-salary state.

What do commercial payers pay for a PA office visit (99213)? Based on price transparency MRF data, market-wide median negotiated rates for a PA-billed 99213 ranged from approximately $64 (Pennsylvania) to $87 (Massachusetts) in our 2025 data. Individual payer rates within a state vary far more widely, from approximately $32 (Aetna fee schedule in Pennsylvania) to $173 (Harvard Pilgrim fee schedule in Massachusetts), for the exact same code.

Are PA reimbursement rates higher in California than in other states? Not based on the MRF data we analyzed. California's combined market median for a 99213 visit is approximately $65, nearly identical to Pennsylvania's $64, despite California PAs earning $30,000 more annually. BCBS/Anthem dominates California's PA professional billing volume at fee schedule rates around $64.

What is the difference between negotiated and fee schedule rates in payer MRF data? Negotiated rates are individually contracted rates between a payer and a specific provider. Fee schedule rates are set amounts applied to categories of providers without individual negotiation. In our analysis, which tier pays more varies by market: in Pennsylvania, fee schedule rates were far below negotiated rates; in Texas, the reverse was true. In Massachusetts, Cigna's fee schedule rates ($136 for 99213) rivaled Harvard Pilgrim's negotiated rates, making Massachusetts unusual in that both its high-rate payers primarily use fee schedule contracts.

Data source: Payer machine-readable files (MRFs) published under 45 CFR 180, accessed May 2025–May 2026. Analysis performed in Gigasheet. Taxonomy 363A00000X, professional billing class, negotiated and fee schedule rate types only.