# CPT 99242: Office or outpatient consultation, low medical decision making

Medicare CPT 99242 pays $75.15 in a non-facility setting and $55.45 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $68.84 in Arkansas to $94.53 in Alaska, a 37% spread.

Web page: https://www.med-reveal.com/rates/99242-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Clinical Genetics (M.D.), Evaluation, Infectious Disease, Optometrist, Pulmonary Disease, Radiology, Thoracic Surgery (Cardiothoracic Vascular Surgery)

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $75.15 |
| National facility | $55.45 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $94.53 | $73.54 |
| District of Columbia | $83.90 | $60.69 |
| California | $82.11 | $58.79 |
| New York | $81.95 | $59.97 |
| New Jersey | $81.83 | $59.64 |
| Washington | $80.94 | $58.47 |
| Massachusetts | $80.35 | $58.21 |
| Hawaii | $79.20 | $56.79 |
| Connecticut | $79.19 | $57.97 |
| Florida | $77.49 | $57.72 |
| Colorado | $77.42 | $56.46 |
| Maryland | $77.37 | $56.82 |
| Rhode Island | $76.80 | $56.44 |
| Oregon | $76.76 | $56.00 |
| New Hampshire | $76.37 | $55.85 |
| Illinois | $76.17 | $57.13 |
| Puerto Rico | $75.52 | $55.60 |
| Virgin Islands | $75.52 | $55.60 |
| Montana | $75.15 | $55.44 |
| Pennsylvania | $74.89 | $55.58 |
| Nevada | $74.80 | $55.07 |
| Delaware | $74.66 | $55.19 |
| Texas | $74.61 | $55.21 |
| Minnesota | $74.57 | $54.29 |
| Wyoming | $74.54 | $54.84 |
| Georgia | $73.97 | $55.18 |
| Michigan | $73.87 | $55.36 |
| Virginia | $73.84 | $54.47 |
| North Dakota | $73.76 | $54.06 |
| Arizona | $73.68 | $54.58 |
| Vermont | $73.63 | $54.12 |
| South Dakota | $73.60 | $53.89 |
| Utah | $72.71 | $54.18 |
| Maine | $72.65 | $53.82 |
| New Mexico | $72.57 | $54.50 |
| Missouri | $72.09 | $54.00 |
| Louisiana | $72.07 | $54.08 |
| South Carolina | $72.01 | $53.80 |
| Wisconsin | $71.99 | $53.11 |
| Ohio | $71.97 | $53.98 |
| North Carolina | $71.85 | $53.46 |
| West Virginia | $71.35 | $54.22 |
| Indiana | $71.27 | $53.00 |
| Idaho | $70.98 | $52.85 |
| Kentucky | $70.88 | $53.36 |
| Nebraska | $70.87 | $52.68 |
| Tennessee | $70.73 | $52.81 |
| Oklahoma | $70.70 | $53.10 |
| Iowa | $70.62 | $52.59 |
| Kansas | $70.47 | $52.65 |
| Alabama | $69.54 | $52.30 |
| Mississippi | $69.43 | $52.47 |
| Arkansas | $68.84 | $51.91 |

## Related codes

- 99243: Office or outpatient consultation, moderate medical decision making (lower) — https://www.med-reveal.com/rates/99243-cpt-fee-schedule
- 99244: Office or outpatient consultation, moderate medical decision making — https://www.med-reveal.com/rates/99244-cpt-fee-schedule
- 99245: Office or outpatient consultation, high medical decision making — https://www.med-reveal.com/rates/99245-cpt-fee-schedule
- 99252: Inpatient or observation consultation, straightforward to low medical decision making — https://www.med-reveal.com/rates/99252-cpt-fee-schedule
- 99253: Inpatient or observation consultation, low medical decision making — https://www.med-reveal.com/rates/99253-cpt-fee-schedule
- 99254: Inpatient or observation consultation, moderate medical decision making — https://www.med-reveal.com/rates/99254-cpt-fee-schedule
- 99255: Inpatient or observation consultation, high medical decision making — https://www.med-reveal.com/rates/99255-cpt-fee-schedule

Commercial negotiated rates for 99242 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