Cost analysis for CPT 99215 — Established patient office or other outpatient, visit typically 40 minutes
Average Medicare Payment
$117.52
2023 data
Total Payments (2023)
$1.3B
Services (2023)
11.1M
Price Change (2014–2023)
+20.3%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $97.65 | $856.3M | 8.6M | — |
| 2015 | $98.81 | $877.0M | 8.7M | +1.2% |
| 2016 | $96.61 | $891.6M | 9.1M | -2.2% |
| 2017 | $96.18 | $902.5M | 9.2M | -0.4% |
| 2018 | $96.59 | $928.4M | 9.4M | +0.4% |
| 2019 | $97.95 | $958.5M | 9.6M | +1.4% |
| 2020 | $97.91 | $786.3M | 7.8M | -0.0% |
| 2021 | $124.55 | $1.3B | 9.9M | +27.2% |
| 2022 | $120.50 | $1.3B | 10.3M | -3.3% |
| 2023 | $117.52 | $1.3B | 11.1M | -2.5% |
The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $149.59 vs ND at $97.98.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $149.59 | $4.4M | 29.2K | 398 |
| NY | $137.01 | $83.9M | 612.5K | 8.3K |
| NJ | $136.69 | $45.0M | 329.0K | 3.7K |
| DC | $133.65 | $8.1M | 60.5K | 656 |
| CA | $133.65 | $220.6M | 1.7M | 15.4K |
| CT | $128.07 | $12.3M | 96.3K | 1.8K |
| FL | $125.25 | $91.2M | 727.8K | 8.5K |
| IL | $123.54 | $63.0M | 510.2K | 6.2K |
| DE | $123.14 | $6.3M | 51.0K | 569 |
| MD | $122.81 | $44.2M | 360.3K | 4.1K |
| HI | $121.83 | $4.2M | 34.4K | 375 |
| MA | $121.58 | $56.7M | 466.7K | 6.4K |
| NV | $121.33 | $9.7M | 79.7K | 792 |
| WY | $120.46 | $1.9M | 15.4K | 222 |
| VA | $119.63 | $38.4M | 320.7K | 4.0K |
| VI | $119.24 | $614.2K | 5.2K | 31 |
| GA | $119.21 | $25.2M | 211.1K | 3.3K |
| AZ | $118.85 | $38.8M | 326.3K | 3.3K |
| WA | $118.49 | $36.1M | 304.7K | 4.3K |
| TX | $118.39 | $80.6M | 680.9K | 8.7K |
| GU | $117.71 | $277.2K | 2.4K | 19 |
| PA | $117.52 | $61.6M | 524.4K | 7.2K |
| SC | $116.33 | $21.9M | 188.0K | 2.4K |
| AE | $114.48 | $41.2K | 360 | 6 |
| MN | $114.46 | $23.8M | 208.2K | 4.1K |
| IN | $113.16 | $19.3M | 170.7K | 2.7K |
| LA | $112.82 | $13.9M | 123.0K | 1.6K |
| AL | $112.40 | $13.8M | 123.1K | 1.7K |
| NC | $111.85 | $43.9M | 392.2K | 5.7K |
| ZZ | $111.69 | $20.2K | 181 | 6 |
| TN | $111.16 | $22.5M | 202.1K | 2.7K |
| CO | $111.12 | $26.1M | 234.9K | 3.2K |
| NH | $110.90 | $7.3M | 66.2K | 1.1K |
| MI | $110.67 | $26.4M | 238.9K | 4.4K |
| NM | $110.61 | $7.5M | 67.9K | 958 |
| KY | $110.36 | $9.1M | 82.3K | 1.4K |
| XX | $110.19 | $53.1K | 482 | 4 |
| MO | $109.96 | $15.5M | 141.2K | 2.3K |
| PR | $109.25 | $312.3K | 2.9K | 52 |
| MS | $109.04 | $8.1M | 74.6K | 900 |
| RI | $108.47 | $2.6M | 24.2K | 463 |
| UT | $107.34 | $8.9M | 83.1K | 1.2K |
| OH | $107.04 | $29.5M | 275.3K | 5.0K |
| OK | $106.76 | $10.8M | 100.8K | 1.3K |
| WV | $106.31 | $3.2M | 29.9K | 467 |
| AR | $105.76 | $7.4M | 70.2K | 874 |
| OR | $105.67 | $14.5M | 137.6K | 2.2K |
| WI | $105.65 | $21.0M | 198.8K | 3.3K |
| NE | $105.42 | $6.4M | 60.8K | 915 |
| VT | $105.40 | $2.9M | 28.0K | 409 |
| IA | $104.86 | $7.8M | 74.5K | 1.2K |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Ian Purcell | Neurology | CA | $622.1K | 4.3K | $144.71 |
| Mark Scholz | Hematology-Oncology | CA | $593.6K | 4.1K | $145.97 |
| Stuart Hetrick | Neurology | AZ | $569.4K | 4.5K | $125.44 |
| William Craig | Cardiology | TX | $480.5K | 3.9K | $123.78 |
| Spyros Mezitis | Endocrinology | NY | $454.9K | 3.0K | $150.23 |
| Jeffrey Mace | Cardiology | CA | $450.9K | 3.1K | $144.89 |
| Criselda Abad-Santos | Psychiatry | CA | $446.5K | 3.1K | $141.74 |
| Jayesh Mehta | Hematology | IL | $438.1K | 3.0K | $146.12 |
| Nikan Khatibi | Anesthesiology | CA | $429.1K | 3.1K | $138.96 |
| Andrew Wong | Internal Medicine | MD | $421.6K | 2.7K | $155.56 |
| Sandeep Thakkar | Neurology | CA | $421.3K | 3.2K | $132.20 |
| Jay Schapira | Cardiology | CA | $349.6K | 2.5K | $140.25 |
| Pingfeng Du | Cardiology | CA | $346.3K | 2.6K | $131.42 |
| Constantin Dasanu | Hematology-Oncology | CA | $339.2K | 3.1K | $111.11 |
| Philip Ngai | Ophthalmology | CA | $325.6K | 2.2K | $149.15 |
| Yousef Khelfa | Internal Medicine | CA | $323.8K | 2.9K | $110.13 |
| Purba Biswas | Internal Medicine | AZ | $315.5K | 2.5K | $125.40 |
| William Chow | Neurology | CA | $310.4K | 2.1K | $148.67 |
| Leo Polosajian | Cardiology | CA | $295.5K | 1.9K | $153.33 |
| Grace Kim | Endocrinology | CA | $291.6K | 1.9K | $153.21 |
Based on the data, CPT 99215 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.
Costs have increased 20.3% 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.