CPT 99403

Prev Med Cnsl&/Rsk Fctr Rdctj Indv Approx 45 Min

CPT 99403 pays $88.18 in a non-facility setting and $62.13 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $81.70 in Arkansas to $113.75 in Alaska, a 39% spread.

National non-facility rate

$88.18

Office and other outpatient settings

Facility rate
$62.13

Hospital and ASC settings

Highest state
$113.75

Alaska

Lowest state
$81.70

Arkansas · 39% 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 $88.18
CPT 99403 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $88.18, national facility $62.13.
StateRate compared visuallyNon-facilityFacility
Alaska
$113.75$86.00
District of Columbia
$97.65$66.96
New York
$95.70$66.63
New Jersey
$95.54$66.20
California
$95.44$64.61
Washington
$94.29$64.59
Massachusetts
$93.69$64.42
Connecticut
$92.54$64.49
Hawaii
$92.09$62.47
Florida
$90.83$64.69
Maryland
$90.58$63.42
Colorado
$90.53$62.81
Rhode Island
$90.03$63.12
Oregon
$89.80$62.35
Illinois
$89.54$64.37
New Hampshire
$89.35$62.23
Puerto Rico
$88.54$62.20
Virgin Islands
$88.54$62.20
Montana
$88.17$62.12
Pennsylvania
$88.05$62.53
Nevada
$87.77$61.69
Delaware
$87.71$61.97
Texas
$87.69$62.04
Wyoming
$87.48$61.43
Minnesota
$87.36$60.55
Georgia
$87.09$62.23
Michigan
$87.03$62.56
Virginia
$86.77$61.16
Arizona
$86.65$61.41
North Dakota
$86.59$60.54
Vermont
$86.49$60.70
South Dakota
$86.40$60.35
Utah
$85.70$61.21
New Mexico
$85.67$61.78
Maine
$85.55$60.65
Louisiana
$85.11$61.32
Missouri
$85.11$61.20
Ohio
$85.00$61.22
South Carolina
$84.99$60.91
Wisconsin
$84.79$59.83
North Carolina
$84.75$60.44
West Virginia
$84.52$61.88
Indiana
$84.12$59.97
Kentucky
$83.87$60.71
Idaho
$83.83$59.86
Nebraska
$83.69$59.64
Oklahoma
$83.65$60.39
Tennessee
$83.60$59.92
Iowa
$83.44$59.61
Kansas
$83.33$59.77
Alabama
$82.43$59.63
Mississippi
$82.37$59.94
Arkansas
$81.70$59.32

Billed by 1 specialties

Commercial rates for 99403

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

See negotiated rates