CPT 99254

Ip/Obs Consltj New/Est Pt Mod Mdm 60 Minutes

CPT 99254 pays $137.61 in a non-facility setting and $137.61 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $129.07 in Arkansas to $183.16 in Alaska, a 42% spread.

National non-facility rate

$137.61

Office and other outpatient settings

Facility rate
$137.61

Hospital and ASC settings

Highest state
$183.16

Alaska

Lowest state
$129.07

Arkansas · 42% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $137.61
CPT 99254 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $137.61, national facility $137.61.
StateRate compared visuallyNon-facilityFacility
Alaska
$183.16$183.16
District of Columbia
$150.47$150.47
New York
$148.71$148.71
New Jersey
$147.94$147.94
California
$145.80$145.80
Washington
$145.03$145.03
Massachusetts
$144.39$144.39
Connecticut
$143.78$143.78
Florida
$143.12$143.12
Illinois
$141.72$141.72
Maryland
$140.98$140.98
Hawaii
$140.85$140.85
Colorado
$140.09$140.09
Rhode Island
$140.08$140.08
Oregon
$138.97$138.97
New Hampshire
$138.59$138.59
Pennsylvania
$137.98$137.98
Puerto Rico
$137.98$137.98
Virgin Islands
$137.98$137.98
Montana
$137.60$137.60
Michigan
$137.42$137.42
Texas
$137.07$137.07
Delaware
$137.00$137.00
Georgia
$136.97$136.97
Nevada
$136.70$136.70
Wyoming
$136.14$136.14
Arizona
$135.52$135.52
New Mexico
$135.34$135.34
Virginia
$135.24$135.24
Minnesota
$134.81$134.81
West Virginia
$134.68$134.68
Utah
$134.57$134.57
Vermont
$134.40$134.40
Louisiana
$134.30$134.30
North Dakota
$134.24$134.24
Missouri
$134.14$134.14
Ohio
$134.08$134.08
South Dakota
$133.84$133.84
Maine
$133.66$133.66
South Carolina
$133.64$133.64
North Carolina
$132.81$132.81
Kentucky
$132.57$132.57
Wisconsin
$131.96$131.96
Oklahoma
$131.95$131.95
Indiana
$131.69$131.69
Idaho
$131.33$131.33
Tennessee
$131.24$131.24
Nebraska
$130.92$130.92
Kansas
$130.85$130.85
Iowa
$130.70$130.70
Mississippi
$130.42$130.42
Alabama
$130.01$130.01
Arkansas
$129.07$129.07

Commercial rates for 99254

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates