CPT 99255

Ip/Obs Consltj New/Est Pt High Mdm 80 Minutes

CPT 99255 pays $184.71 in a non-facility setting and $184.71 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $174.20 in Arkansas to $248.85 in Alaska, a 43% spread.

National non-facility rate

$184.71

Office and other outpatient settings

Facility rate
$184.71

Hospital and ASC settings

Highest state
$248.85

Alaska

Lowest state
$174.20

Arkansas · 43% 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 $184.71
CPT 99255 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $184.71, national facility $184.71.
StateRate compared visuallyNon-facilityFacility
Alaska
$248.85$248.85
District of Columbia
$201.10$201.10
New York
$199.14$199.14
New Jersey
$198.04$198.04
California
$194.63$194.63
Washington
$193.88$193.88
Massachusetts
$193.12$193.12
Connecticut
$192.60$192.60
Florida
$192.14$192.14
Illinois
$190.53$190.53
Maryland
$189.02$189.02
Hawaii
$188.06$188.06
Rhode Island
$187.91$187.91
Colorado
$187.65$187.65
Oregon
$186.19$186.19
New Hampshire
$185.72$185.72
Pennsylvania
$185.41$185.41
Puerto Rico
$185.12$185.12
Virgin Islands
$185.12$185.12
Michigan
$184.90$184.90
Montana
$184.69$184.69
Georgia
$184.20$184.20
Texas
$184.12$184.12
Delaware
$184.00$184.00
Nevada
$183.47$183.47
Wyoming
$182.71$182.71
New Mexico
$182.26$182.26
Arizona
$182.11$182.11
West Virginia
$181.72$181.72
Virginia
$181.63$181.63
Utah
$181.04$181.04
Louisiana
$180.88$180.88
Minnesota
$180.69$180.69
Missouri
$180.63$180.63
Ohio
$180.58$180.58
Vermont
$180.43$180.43
North Dakota
$180.14$180.14
South Carolina
$179.90$179.90
Maine
$179.70$179.70
South Dakota
$179.61$179.61
Kentucky
$178.72$178.72
North Carolina
$178.71$178.71
Oklahoma
$177.85$177.85
Wisconsin
$177.37$177.37
Indiana
$177.25$177.25
Idaho
$176.81$176.81
Tennessee
$176.77$176.77
Kansas
$176.28$176.28
Nebraska
$176.23$176.23
Mississippi
$176.02$176.02
Iowa
$175.99$175.99
Alabama
$175.36$175.36
Arkansas
$174.20$174.20

Commercial rates for 99255

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

See negotiated rates