# CPT 99213: Established patient office/outpatient visit, low medical decision making

Medicare CPT 99213 pays $95.19 in a non-facility setting and $57.45 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $86.86 in Arkansas to $118.72 in Alaska, a 37% spread.

Web page: https://www.med-reveal.com/rates/99213-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Allergy & Immunology, Cardiovascular Disease, Child & Adolescent Psychiatry, Clinic/Center, Clinical Genetics (M.D.), Dermatology, Endocrinology, Evaluation, Family Medicine, Gastroenterology, General Surgery, Hematology & Oncology, Infectious Disease, Internal Medicine, Methadone Clinic, Neurological Surgery, Neurology, Obstetrics & Gynecology, Ophthalmology, Optometrist, Orthopaedic Surgery, Otolaryngology, Pain Medicine, Pediatrics, Plastic Surgery, Psychiatry & Neurology, Pulmonary Disease, Rheumatology, Sleep Medicine, Sports Medicine, Thoracic Surgery (Cardiothoracic Vascular Surgery), Urology, Vascular Surgery

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $95.19 |
| National facility | $57.45 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $118.72 | $78.53 |
| District of Columbia | $106.56 | $62.10 |
| California | $104.31 | $59.65 |
| New York | $103.97 | $61.86 |
| New Jersey | $103.82 | $61.32 |
| Washington | $102.75 | $59.73 |
| Massachusetts | $101.98 | $59.58 |
| Hawaii | $100.61 | $57.69 |
| Connecticut | $100.45 | $59.80 |
| Florida | $98.20 | $60.33 |
| Colorado | $98.18 | $58.02 |
| Maryland | $98.07 | $58.72 |
| Oregon | $97.32 | $57.56 |
| Rhode Island | $97.30 | $58.31 |
| New Hampshire | $96.82 | $57.53 |
| Illinois | $96.44 | $59.97 |
| Puerto Rico | $95.68 | $57.53 |
| Virgin Islands | $95.68 | $57.53 |
| Montana | $95.19 | $57.44 |
| Pennsylvania | $94.79 | $57.82 |
| Nevada | $94.74 | $56.96 |
| Delaware | $94.52 | $57.23 |
| Minnesota | $94.49 | $55.65 |
| Texas | $94.46 | $57.30 |
| Wyoming | $94.41 | $56.67 |
| Georgia | $93.60 | $57.60 |
| Virginia | $93.48 | $56.38 |
| Michigan | $93.45 | $58.01 |
| North Dakota | $93.41 | $55.66 |
| Arizona | $93.25 | $56.67 |
| Vermont | $93.22 | $55.85 |
| South Dakota | $93.20 | $55.45 |
| Utah | $91.96 | $56.48 |
| Maine | $91.90 | $55.84 |
| New Mexico | $91.75 | $57.14 |
| Missouri | $91.13 | $56.50 |
| Louisiana | $91.09 | $56.64 |
| Wisconsin | $91.06 | $54.91 |
| South Carolina | $91.04 | $56.16 |
| Ohio | $90.97 | $56.51 |
| North Carolina | $90.84 | $55.63 |
| West Virginia | $90.10 | $57.30 |
| Indiana | $90.09 | $55.10 |
| Idaho | $89.71 | $54.98 |
| Nebraska | $89.57 | $54.73 |
| Kentucky | $89.52 | $55.97 |
| Tennessee | $89.36 | $55.05 |
| Oklahoma | $89.30 | $55.60 |
| Iowa | $89.23 | $54.70 |
| Kansas | $89.02 | $54.90 |
| Alabama | $87.79 | $54.77 |
| Mississippi | $87.63 | $55.13 |
| Arkansas | $86.86 | $54.44 |

## Related codes

- 99211: Established patient office/outpatient visit, may not require physician presence — https://www.med-reveal.com/rates/99211-cpt-fee-schedule
- 99212: Established patient office/outpatient visit, straightforward medical decision making — https://www.med-reveal.com/rates/99212-cpt-fee-schedule
- 99214: Established patient office/outpatient visit, moderate medical decision making — https://www.med-reveal.com/rates/99214-cpt-fee-schedule
- 99215: Established patient office/outpatient visit, high medical decision making — https://www.med-reveal.com/rates/99215-cpt-fee-schedule

Commercial negotiated rates for 99213 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules