Medicare rate for CPT 99213 in 2026
Medicare’s national 2026 allowed amount for CPT 99213 is $95.19 in a physician’s office and $57.45 in a facility, from the CMS 2026 October release. The office figure applies when the service is performed in a physician’s office and the facility figure when it is performed in a hospital or other facility. Both figures are the doctor’s fee, and both are national amounts before geographic adjustment. What a specific provider is actually paid depends on the Medicare locality they practice in.
Established patient office visit, low complexity
The hospital figure is the doctor’s fee, not the hospital’s. It is what Medicare pays the doctor when the service is done inside a hospital. The hospital is paid its own amount. That amount comes from a different Medicare schedule: OPPS for outpatient care, MS-DRG for an inpatient stay. This page does not show it.
Code name above: S2Reason’s own label. CMS’s CPT descriptor is AMA-licensed text and is not shown · Status A: Active, payable · Source: CMS 2026 October (RVU26D, non-QP conversion factor), effective 10/2026.
The most commonly billed office visit in the United States, and the one a reviewer sees most often on a treating-provider bill.
What CPT 99213 means
An office or outpatient visit with a patient the practice has seen before. The level is chosen by how complex the doctor's medical decision making was, or by the doctor's total time on the day of the visit. On an injury claim it is the typical follow-up visit with a treating physician.
How the $95.19 is built
Work RVU 1.30, practice-expense RVU 1.46 in an office and 0.33 in a facility, malpractice RVU 0.09. Each is multiplied by its geographic index, added together, then multiplied by the 2026 conversion factor of $33.4009. With every index at 1.000 that gives $95.19 in an office and $57.45 in a facility.
This is the allowed amount for one unit, before the 2% sequestration reduction and before any multiple-procedure reduction. It is what Medicare allows, not what a commercial carrier or an auto policy allows, and not what the provider billed. Current Procedural Terminology (CPT) is copyright 1995–2025 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.
What CPT 99213 pays in New Jersey
New Jersey has 2 Medicare localities, so there is no single New Jersey rate. In an office the allowed amount runs from $101.71 to $105.93, a spread of 4.1% across the state.
| Locality | Office | Facilitydoctor’s fee, not the hospital’s |
|---|---|---|
| Northern NJ | $105.93 | $62.15 |
| Rest Of New Jersey | $101.71 | $60.49 |
CPT 99213 by fee-schedule year, 2023 to 2026
A bill is priced under the schedule in force on its date of service, not the one in force when it is reviewed. Note that 2024 has two entries: Congress changed the conversion factor on 9 March 2024, so a January 2024 date of service and a June 2024 date of service price differently.
| Fee-schedule year | Conversion factor | Office | Facilitydoctor’s fee, not the hospital’s |
|---|---|---|---|
| 2026 | $33.4009 | $95.19 | $57.45 |
| 2025 | $32.3465 | $88.95 | $63.72 |
| 2024 (Mar 9 to Dec 31) | $33.2875 | $90.87 | $65.24 |
| 2024 (Jan 1 to Mar 8) | $32.7442 | $89.39 | $64.18 |
| 2023 | $33.8872 | $90.82 | $66.08 |
National amounts, every geographic index at 1.000, so the year-to-year movement here is the fee schedule changing and not a change of location.
CPT 99213 in every state
The office allowed amount in each state, highest locality to lowest. Where a state shows one figure it has a single Medicare locality.
| State | Highest | Lowest | Localities |
|---|---|---|---|
| California | $120.13 | $99.22 | 29 |
| Alaska | $118.72 | - | 1 |
| New York | $109.76 | $91.86 | 5 |
| Washington | $107.88 | $97.62 | 2 |
| District of Columbia | $106.56 | - | 1 |
| Massachusetts | $106.10 | $97.86 | 2 |
| New Jersey | $105.93 | $101.71 | 2 |
| Florida | $101.79 | $94.56 | 3 |
| Hawaii / Guam | $100.61 | - | 1 |
| Oregon | $100.53 | $94.10 | 2 |
| Connecticut | $100.45 | - | 1 |
| Maryland | $100.16 | $95.97 | 2 |
| Illinois | $99.63 | $92.64 | 4 |
| Pennsylvania | $98.55 | $91.03 | 2 |
| Colorado | $98.18 | - | 1 |
| Texas | $97.77 | $90.59 | 8 |
| Rhode Island | $97.30 | - | 1 |
| New Hampshire | $96.82 | - | 1 |
| Georgia | $96.71 | $90.50 | 2 |
| Puerto Rico | $95.68 | - | 1 |
| Virgin Islands | $95.68 | - | 1 |
| Michigan | $95.55 | $91.34 | 2 |
| Montana | $95.19 | - | 1 |
| Nevada | $94.74 | - | 1 |
| Delaware | $94.52 | - | 1 |
| Minnesota | $94.49 | - | 1 |
| Wyoming | $94.41 | - | 1 |
| Maine | $93.64 | $90.16 | 2 |
| Virginia | $93.48 | - | 1 |
| North Dakota | $93.41 | - | 1 |
| Arizona | $93.25 | - | 1 |
| Vermont | $93.22 | - | 1 |
| South Dakota | $93.20 | - | 1 |
| Missouri | $92.86 | $88.38 | 3 |
| Louisiana | $92.72 | $89.46 | 2 |
| Utah | $91.96 | - | 1 |
| New Mexico | $91.75 | - | 1 |
| Wisconsin | $91.06 | - | 1 |
| South Carolina | $91.04 | - | 1 |
| Ohio | $90.97 | - | 1 |
| North Carolina | $90.84 | - | 1 |
| West Virginia | $90.10 | - | 1 |
| Indiana | $90.09 | - | 1 |
| Idaho | $89.71 | - | 1 |
| Nebraska | $89.57 | - | 1 |
| Kentucky | $89.52 | - | 1 |
| Tennessee | $89.36 | - | 1 |
| Oklahoma | $89.30 | - | 1 |
| Iowa | $89.23 | - | 1 |
| Kansas | $89.02 | - | 1 |
| Alabama | $87.79 | - | 1 |
| Mississippi | $87.63 | - | 1 |
| Arkansas | $86.86 | - | 1 |
Checking a different code, state or year
The Medicare rate lookup prices all 17,000-plus codes in the Physician Fee Schedule for any state and any fee-schedule year from 2023 to 2026. Ambulance codes are priced separately on the ambulance fee schedule, because Medicare does not pay for ambulance transport under this schedule at all.
Other office visits codes
- CPT 99214 Established patient office visit, moderate complexity
- CPT 99204 New patient office visit, moderate complexity
- CPT 99203 New patient office visit, low complexity
- CPT 99205 New patient office visit, high complexity
Other codes with a rate page
- CPT 99284 Emergency department visit, moderate complexity
- CPT 72148 MRI, lumbar spine, without contrast
- CPT 72141 MRI, cervical spine, without contrast
- CPT 70450 CT, head or brain, without contrast
- CPT 64483 Epidural steroid injection, lumbar, first level
- CPT 97110 Therapeutic exercise, each 15 minutes
Medicare rates are a benchmark, not an allowance. What a no-fault, workers’ compensation or commercial carrier owes for CPT 99213 is set by the fee schedule or policy that governs the claim, which is frequently a multiple of the figure above.
One code is one line of a bill.
Desk prices a whole case against the schedule that actually governs the claim, with every line cited to the document it came from. Fair Measure Billing Experts prepares and signs the report when you need someone else to write it.