How much does Medicare pay for CPT 99091?

Medicare allowed an average of $53.99 per service and paid $42.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $91.46, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99091 pay differently in an office than a hospital?

Yes. The allowed amount averaged $54.00 in an office setting and $49.29 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99091 most?

Family Practice, with 68,380 services from 30 clinicians. Next are Emergency Medicine, Internal Medicine, Cardiology.

CPT 99091

Collection and interpretation of physical parameters stored in computers and/or transmitted by the patient and/or caregiver to qualified health care professional, requiring 30 minutes or more, per 30 days

$53.99Medicare-allowed amount per service, averaged across 171,807 services

Providers submitted

$91.46

Asking price, not received

Medicare allowed

$53.99

The fee schedule figure

Medicare paid

$42.11

Balance is patient coinsurance

Providers submitted an average of $91.46 for this code and Medicare allowed $53.99 — 1.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $42.11 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $54.00
Hospital / facility: $49.29

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 171,485 services were billed in an office setting and 322 in a facility.

Services: 171,807
Beneficiaries: 42,607
Providers billing it: 264
Total allowed: $9,275,860

What Medicare pays for CPT 99091

Across 171,807 services billed by 264 providers to 42,607 beneficiaries, Medicare allowed an average of $53.99 per service. That is 4.0 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99091

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	68,380	15,696	$53.86	30
Emergency Medicine	33,156	8,476	$55.41	3
Internal Medicine	21,612	5,095	$54.54	66
Cardiology	15,414	3,363	$54.31	40
Interventional Cardiology	4,901	973	$54.95	9
Nurse Practitioner	4,631	1,565	$43.97	30
Pulmonary Disease	4,449	1,875	$53.40	17
Sleep Medicine	4,390	1,621	$52.80	14
Clinical Cardiac Electrophysiology	4,248	600	$55.50	6
Physical Medicine and Rehabilitation	3,518	606	$52.19	1
Endocrinology	1,727	356	$54.11	9
General Practice	1,270	279	$55.66	3
Nephrology	1,160	468	$56.93	6
Neurology	1,011	577	$52.92	4
Physician Assistant	765	481	$43.51	6

99091 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	75,221	$53.56	$41.49	59
Florida	35,235	$55.24	$41.22	14
California	26,347	$55.91	$40.60	67
New Jersey	9,909	$54.98	$39.40	21
Georgia	6,826	$52.05	$38.60	8
Arizona	4,810	$53.10	$40.59	21
Michigan	1,861	$54.31	$41.22	7
North Carolina	1,846	$47.41	$39.48	6
Illinois	1,178	$52.24	$38.91	4
Tennessee	1,126	$42.49	$33.48	3
Alabama	1,038	$50.04	$40.27	9
New York	996	$57.42	$39.12	5
Mississippi	975	$42.69	$35.16	3
Oklahoma	733	$48.65	$37.79	3
Nevada	698	$45.77	$37.70	5
Ohio	555	$53.42	$38.32	1
Maryland	552	$54.92	$39.02	4
West Virginia	409	$51.03	$38.34	2
Missouri	340	$51.91	$38.23	4
Kansas	223	$46.69	$40.09	1
Virginia	169	$51.87	$39.60	2
Louisiana	107	$50.68	$37.47	1
District of Columbia	100	$57.74	$40.25	1
Pennsylvania	98	$52.58	$37.54	1
Wisconsin	83	$42.36	$32.13	1
Oregon	82	$43.77	$33.94	1
Washington	80	$48.40	$36.64	4
North Dakota	71	$52.39	$42.01	1
Massachusetts	46	$53.68	$42.02	1
Arkansas	37	$45.97	$36.35	2
South Carolina	28	$43.37	$35.72	1
Colorado	28	$53.19	$41.92	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.