Medicare rate for CPT 99213 in 2026
Established patient office visit, low complexity
Medicare’s 2026 allowed amount for CPT 99213 is $95.19 when the service is performed in a physician’s office and $57.45 when it is performed in a hospital or other facility. Both are national amounts before geographic adjustment. What a specific provider is actually paid depends on the Medicare locality they practise in.
CMS short descriptor: Office o/p est low 20 min · Status A: Active, payable · Source: CMS 2026 July (RVU26C, non-QP conversion factor), effective 7/2026.
The most commonly billed office visit in the United States, and the one a reviewer sees most often on a treating-provider bill.
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.
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 4.2% across the state.
| Locality | Office | Facility |
|---|---|---|
| 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 | Facility |
|---|---|---|---|
| 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
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. Talk to us about pricing a bill against the schedule that actually applies to it.