# CPT 99243: Office or outpatient consultation, moderate medical decision making (lower)

Medicare CPT 99243 pays $112.56 in a non-facility setting and $87.51 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $103.90 in Arkansas to $144.14 in Alaska, a 39% spread.

Web page: https://www.med-reveal.com/rates/99243-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 | $112.56 |
| National facility | $87.51 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $144.14 | $117.46 |
| District of Columbia | $124.90 | $95.39 |
| New York | $122.37 | $94.42 |
| New Jersey | $122.11 | $93.90 |
| California | $121.97 | $92.33 |
| Washington | $120.51 | $91.95 |
| Massachusetts | $119.72 | $91.58 |
| Connecticut | $118.29 | $91.31 |
| Hawaii | $117.70 | $89.21 |
| Florida | $116.20 | $91.07 |
| Maryland | $115.70 | $89.58 |
| Colorado | $115.60 | $88.94 |
| Rhode Island | $114.92 | $89.04 |
| Oregon | $114.64 | $88.24 |
| Illinois | $114.47 | $90.27 |
| New Hampshire | $114.10 | $88.02 |
| Puerto Rico | $113.04 | $87.72 |
| Virgin Islands | $113.04 | $87.72 |
| Montana | $112.55 | $87.50 |
| Pennsylvania | $112.35 | $87.82 |
| Nevada | $112.00 | $86.92 |
| Delaware | $111.91 | $87.16 |
| Texas | $111.88 | $87.21 |
| Wyoming | $111.61 | $86.56 |
| Minnesota | $111.39 | $85.61 |
| Georgia | $111.13 | $87.23 |
| Michigan | $111.08 | $87.56 |
| Virginia | $110.65 | $86.03 |
| Arizona | $110.52 | $86.25 |
| North Dakota | $110.38 | $85.33 |
| Vermont | $110.26 | $85.46 |
| South Dakota | $110.12 | $85.07 |
| Utah | $109.26 | $85.71 |
| New Mexico | $109.25 | $86.28 |
| Maine | $109.02 | $85.08 |
| Louisiana | $108.49 | $85.62 |
| Missouri | $108.49 | $85.50 |
| Ohio | $108.35 | $85.48 |
| South Carolina | $108.30 | $85.16 |
| North Carolina | $107.97 | $84.60 |
| Wisconsin | $107.97 | $83.97 |
| West Virginia | $107.76 | $85.99 |
| Indiana | $107.11 | $83.89 |
| Kentucky | $106.84 | $84.57 |
| Idaho | $106.72 | $83.68 |
| Nebraska | $106.52 | $83.40 |
| Oklahoma | $106.52 | $84.15 |
| Tennessee | $106.42 | $83.65 |
| Iowa | $106.20 | $83.28 |
| Kansas | $106.06 | $83.41 |
| Alabama | $104.87 | $82.95 |
| Mississippi | $104.82 | $83.26 |
| Arkansas | $103.90 | $82.38 |

## Related codes

- 99242: Office or outpatient consultation, low medical decision making — https://www.med-reveal.com/rates/99242-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 99243 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