Cost analysis for CPT 99213 — Established patient office or other outpatient visit, typically 15 minutes
Average Medicare Payment
$55.97
2023 data
Total Payments (2023)
$4.1B
Services (2023)
70.2M
Price Change (2014–2023)
+19.3%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $46.90 | $4.8B | 99.7M | — |
| 2015 | $46.59 | $4.8B | 98.7M | -0.7% |
| 2016 | $45.84 | $4.7B | 98.7M | -1.6% |
| 2017 | $45.39 | $4.5B | 96.5M | -1.0% |
| 2018 | $45.46 | $4.4B | 93.7M | +0.2% |
| 2019 | $46.74 | $4.5B | 91.3M | +2.8% |
| 2020 | $46.25 | $3.6B | 74.8M | -1.0% |
| 2021 | $58.76 | $4.6B | 74.6M | +27.0% |
| 2022 | $57.08 | $4.3B | 72.4M | -2.9% |
| 2023 | $55.97 | $4.1B | 70.2M | -1.9% |
The most expensive state pays 2.0x more than the cheapest for this procedure. AK averages $70.55 vs MP at $35.98.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $70.55 | $10.9M | 155.1K | 1.3K |
| NY | $69.26 | $379.9M | 5.5M | 31.4K |
| DC | $67.19 | $10.3M | 152.7K | 1.2K |
| NJ | $67.01 | $184.1M | 2.7M | 14.1K |
| CA | $66.11 | $457.9M | 6.9M | 34.7K |
| XX | $64.47 | $207.3K | 3.2K | 11 |
| CT | $63.38 | $51.9M | 818.3K | 6.4K |
| MD | $61.72 | $116.1M | 1.9M | 9.3K |
| FL | $60.83 | $361.6M | 5.9M | 30.0K |
| MA | $60.54 | $120.6M | 2.0M | 13.7K |
| AE | $59.87 | $183.2K | 3.1K | 17 |
| IL | $59.58 | $152.3M | 2.6M | 17.4K |
| RI | $58.77 | $14.4M | 245.6K | 1.9K |
| DE | $58.77 | $24.5M | 417.0K | 1.8K |
| NV | $58.76 | $34.8M | 592.8K | 3.5K |
| HI | $58.59 | $12.3M | 210.3K | 1.5K |
| GU | $58.48 | $1.0M | 17.8K | 98 |
| VA | $58.45 | $124.4M | 2.1M | 12.4K |
| PR | $58.01 | $6.4M | 109.9K | 1.5K |
| AA | $57.65 | $17.9K | 310 | 2 |
| PA | $57.38 | $171.4M | 3.0M | 22.4K |
| TX | $57.33 | $250.5M | 4.4M | 29.8K |
| CO | $57.14 | $47.3M | 827.6K | 7.2K |
| WA | $57.02 | $63.3M | 1.1M | 9.7K |
| AZ | $56.95 | $92.4M | 1.6M | 9.6K |
| GA | $56.58 | $122.4M | 2.2M | 13.4K |
| MI | $55.82 | $97.7M | 1.8M | 14.8K |
| SC | $55.63 | $83.1M | 1.5M | 7.7K |
| WY | $55.23 | $8.4M | 152.0K | 849 |
| ZZ | $55.03 | $59.2K | 1.1K | 15 |
| LA | $54.76 | $49.1M | 897.4K | 6.1K |
| UT | $54.75 | $23.5M | 428.3K | 3.7K |
| AP | $54.63 | $54.0K | 989 | 13 |
| NC | $54.49 | $116.0M | 2.1M | 16.3K |
| OR | $54.43 | $31.5M | 578.1K | 5.5K |
| NH | $54.18 | $20.1M | 370.1K | 2.9K |
| AL | $54.00 | $50.8M | 940.6K | 6.5K |
| MN | $53.78 | $36.7M | 681.6K | 9.1K |
| MO | $53.72 | $61.5M | 1.1M | 8.7K |
| IN | $53.53 | $81.9M | 1.5M | 10.8K |
| NM | $53.37 | $17.8M | 332.9K | 2.4K |
| TN | $53.19 | $87.8M | 1.7M | 11.0K |
| VI | $52.90 | $600.7K | 11.4K | 79 |
| KS | $52.76 | $37.5M | 711.6K | 4.3K |
| OK | $52.65 | $47.5M | 902.2K | 5.4K |
| KY | $52.16 | $55.5M | 1.1M | 7.2K |
| OH | $52.01 | $131.3M | 2.5M | 20.0K |
| IA | $51.83 | $37.7M | 727.6K | 4.7K |
| MT | $51.70 | $12.5M | 241.9K | 1.7K |
| MS | $51.48 | $41.3M | 801.9K | 4.0K |
| NE | $51.33 | $25.3M | 492.9K | 3.2K |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Michael Mcginnis | Pathology | CA | $1.4M | 15.9K | $90.30 |
| Sayed Monis | Neurology | CA | $877.0K | 12.8K | $68.29 |
| Harry Lifschutz | General Surgery | CA | $793.9K | 12.5K | $63.52 |
| Mehrdad Pakdaman | Family Practice | CA | $782.9K | 10.3K | $76.29 |
| Jaewoo Pak | Internal Medicine | CA | $773.9K | 9.9K | $78.18 |
| Young-Jik Lee | Internal Medicine | CA | $765.6K | 10.0K | $76.30 |
| Seth Camhi | Family Practice | CA | $696.4K | 9.1K | $76.90 |
| Victor Fariwa | Internal Medicine | NY | $661.9K | 8.2K | $81.13 |
| Anselmo Mendive | Family Practice | FL | $550.4K | 7.3K | $75.70 |
| Vagharshak Pilossyan | Internal Medicine | CA | $549.4K | 7.7K | $70.98 |
| Robert Morton | Psychiatry | OK | $509.8K | 9.0K | $56.84 |
| Hrach Khudatyan | Family Practice | CA | $491.4K | 6.5K | $76.03 |
| Susan Yeager | Podiatry | CA | $482.7K | 6.9K | $69.64 |
| Rafayel Gevorkian | General Practice | CA | $479.6K | 6.5K | $73.36 |
| Zaven Arslanian | General Practice | CA | $476.6K | 6.4K | $74.76 |
| Edwin Yau | Family Practice | CA | $458.0K | 5.9K | $77.23 |
| Kamran Kalpari | Internal Medicine | CA | $454.9K | 7.8K | $58.19 |
| Wassim Shaheen | Interventional Cardiology | KS | $450.2K | 7.3K | $61.46 |
| John Kim | Internal Medicine | VA | $436.6K | 5.6K | $77.70 |
| Tai Wu | Internal Medicine | CA | $404.2K | 5.6K | $72.80 |
Based on the data, CPT 99213 shows a 2.0x variation in pricing across states — moderate variation by Medicare standards.
Costs have increased 19.3% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.