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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. 99213
  4. Cost Analysis

How Much Does Established patient office or other outpatient visit, typically 15 minutes Cost on Medicare?

Cost analysis for CPT 99213 — Established patient office or other outpatient visit, typically 15 minutes

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Average Medicare Payment

$55.97

2023 data

Total Payments (2023)

$4.1B

Services (2023)

70.2M

Price Change (2014–2023)

+19.3%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$46.90$4.8B99.7M—
2015$46.59$4.8B98.7M-0.7%
2016$45.84$4.7B98.7M-1.6%
2017$45.39$4.5B96.5M-1.0%
2018$45.46$4.4B93.7M+0.2%
2019$46.74$4.5B91.3M+2.8%
2020$46.25$3.6B74.8M-1.0%
2021$58.76$4.6B74.6M+27.0%
2022$57.08$4.3B72.4M-2.9%
2023$55.97$4.1B70.2M-1.9%

🗺️ State-by-State Cost Variation

The most expensive state pays 2.0x more than the cheapest for this procedure. AK averages $70.55 vs MP at $35.98.

StateAvg PaymentTotal PaymentsServicesProviders
AK$70.55$10.9M155.1K1.3K
NY$69.26$379.9M5.5M31.4K
DC$67.19$10.3M152.7K1.2K
NJ$67.01$184.1M2.7M14.1K
CA$66.11$457.9M6.9M34.7K
XX$64.47$207.3K3.2K11
CT$63.38$51.9M818.3K6.4K
MD$61.72$116.1M1.9M9.3K
FL$60.83$361.6M5.9M30.0K
MA$60.54$120.6M2.0M13.7K
AE$59.87$183.2K3.1K17
IL$59.58$152.3M2.6M17.4K
RI$58.77$14.4M245.6K1.9K
DE$58.77$24.5M417.0K1.8K
NV$58.76$34.8M592.8K3.5K
HI$58.59$12.3M210.3K1.5K
GU$58.48$1.0M17.8K98
VA$58.45$124.4M2.1M12.4K
PR$58.01$6.4M109.9K1.5K
AA$57.65$17.9K3102
PA$57.38$171.4M3.0M22.4K
TX$57.33$250.5M4.4M29.8K
CO$57.14$47.3M827.6K7.2K
WA$57.02$63.3M1.1M9.7K
AZ$56.95$92.4M1.6M9.6K
GA$56.58$122.4M2.2M13.4K
MI$55.82$97.7M1.8M14.8K
SC$55.63$83.1M1.5M7.7K
WY$55.23$8.4M152.0K849
ZZ$55.03$59.2K1.1K15
LA$54.76$49.1M897.4K6.1K
UT$54.75$23.5M428.3K3.7K
AP$54.63$54.0K98913
NC$54.49$116.0M2.1M16.3K
OR$54.43$31.5M578.1K5.5K
NH$54.18$20.1M370.1K2.9K
AL$54.00$50.8M940.6K6.5K
MN$53.78$36.7M681.6K9.1K
MO$53.72$61.5M1.1M8.7K
IN$53.53$81.9M1.5M10.8K
NM$53.37$17.8M332.9K2.4K
TN$53.19$87.8M1.7M11.0K
VI$52.90$600.7K11.4K79
KS$52.76$37.5M711.6K4.3K
OK$52.65$47.5M902.2K5.4K
KY$52.16$55.5M1.1M7.2K
OH$52.01$131.3M2.5M20.0K
IA$51.83$37.7M727.6K4.7K
MT$51.70$12.5M241.9K1.7K
MS$51.48$41.3M801.9K4.0K
NE$51.33$25.3M492.9K3.2K

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Michael McginnisPathologyCA$1.4M15.9K$90.30
Sayed MonisNeurologyCA$877.0K12.8K$68.29
Harry LifschutzGeneral SurgeryCA$793.9K12.5K$63.52
Mehrdad PakdamanFamily PracticeCA$782.9K10.3K$76.29
Jaewoo PakInternal MedicineCA$773.9K9.9K$78.18
Young-Jik LeeInternal MedicineCA$765.6K10.0K$76.30
Seth CamhiFamily PracticeCA$696.4K9.1K$76.90
Victor FariwaInternal MedicineNY$661.9K8.2K$81.13
Anselmo MendiveFamily PracticeFL$550.4K7.3K$75.70
Vagharshak PilossyanInternal MedicineCA$549.4K7.7K$70.98
Robert MortonPsychiatryOK$509.8K9.0K$56.84
Hrach KhudatyanFamily PracticeCA$491.4K6.5K$76.03
Susan YeagerPodiatryCA$482.7K6.9K$69.64
Rafayel GevorkianGeneral PracticeCA$479.6K6.5K$73.36
Zaven ArslanianGeneral PracticeCA$476.6K6.4K$74.76
Edwin YauFamily PracticeCA$458.0K5.9K$77.23
Kamran KalpariInternal MedicineCA$454.9K7.8K$58.19
Wassim ShaheenInterventional CardiologyKS$450.2K7.3K$61.46
John KimInternal MedicineVA$436.6K5.6K$77.70
Tai WuInternal MedicineCA$404.2K5.6K$72.80

🤔 Is Established patient office or other outpatient visit, typically 15 minutes Overpriced?

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.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.