How much does Medicare pay for CPT 99202?

Medicare allowed an average of $67.19 per service and paid $44.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $166.18, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99202?

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more. It was billed 554,116 times to 554,062 Medicare beneficiaries by 17,327 providers in 2024.

Does 99202 pay differently in an office than a hospital?

Yes. The allowed amount averaged $68.30 in an office setting and $44.34 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 99202 most?

Dermatology, with 104,782 services from 3,150 clinicians. Next are Podiatry, Physician Assistant, Nurse Practitioner.

CPT 99202

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more

$67.19Medicare-allowed amount per service, averaged across 554,116 services

Providers submitted

$166.18

Asking price, not received

Medicare allowed

$67.19

The fee schedule figure

Medicare paid

$44.16

Balance is patient coinsurance

Providers submitted an average of $166.18 for this code and Medicare allowed $67.19 — 2.5× 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 $44.16 (66%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $68.30
Hospital / facility: $44.34

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. 528,335 services were billed in an office setting and 25,781 in a facility.

Services: 554,116
Beneficiaries: 554,062
Providers billing it: 17,327
Total allowed: $37,231,054

What Medicare pays for CPT 99202

Across 554,116 services billed by 17,327 providers to 554,062 beneficiaries, Medicare allowed an average of $67.19 per service. 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 99202

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	104,782	104,780	$71.13	3,150
Podiatry	95,233	95,222	$69.72	2,230
Physician Assistant	71,109	71,108	$59.37	2,628
Nurse Practitioner	67,339	67,335	$58.42	2,455
Otolaryngology	27,349	27,348	$69.94	816
General Surgery	23,125	23,122	$66.01	845
Gastroenterology	20,541	20,539	$72.83	655
Orthopedic Surgery	15,861	15,859	$68.69	513
Family Practice	14,656	14,652	$71.61	493
Plastic and Reconstructive Surgery	12,337	12,331	$69.55	322
Physical Medicine and Rehabilitation	8,988	8,986	$69.00	168
Internal Medicine	8,667	8,662	$70.99	280
Ophthalmology	7,613	7,613	$69.51	273
Optometry	6,126	6,126	$68.40	291
Vascular Surgery	6,111	6,108	$69.63	193

99202 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
California	47,903	$74.86	$45.24	1,330
New York	42,049	$76.09	$47.47	1,208
Florida	39,016	$67.17	$45.26	1,159
Texas	33,704	$66.84	$44.04	1,042
Pennsylvania	29,062	$66.76	$45.03	888
Illinois	23,029	$66.40	$43.08	785
Ohio	21,142	$60.93	$41.49	733
New Jersey	20,910	$74.88	$46.62	647
Virginia	18,221	$67.07	$44.12	518
North Carolina	17,212	$63.26	$42.54	553
Maryland	16,019	$71.85	$44.52	490
Massachusetts	15,144	$70.46	$45.04	468
Georgia	14,235	$64.37	$43.56	490
Michigan	14,110	$66.13	$43.70	485
Arizona	13,516	$64.96	$41.92	422
Indiana	11,638	$62.66	$42.61	402
Tennessee	11,166	$61.85	$44.05	366
South Carolina	10,711	$64.68	$44.41	317
Missouri	10,682	$61.36	$42.41	327
Wisconsin	9,170	$59.01	$40.36	326
Washington	9,027	$67.32	$42.92	309
Connecticut	8,424	$71.15	$44.64	303
Louisiana	7,862	$64.62	$45.03	204
Oklahoma	6,973	$61.69	$43.11	189
Alabama	6,890	$61.38	$44.12	221
Mississippi	6,824	$58.78	$44.55	164
Minnesota	6,681	$66.70	$46.40	270
Iowa	6,574	$60.79	$42.84	206
Arkansas	6,553	$59.43	$43.41	190
Colorado	6,214	$67.85	$42.39	241
Kentucky	5,998	$61.99	$43.08	205
Kansas	5,306	$62.01	$44.09	164
West Virginia	4,608	$60.16	$41.64	139
Nebraska	4,307	$61.49	$43.79	127
Oregon	4,295	$66.52	$42.89	157
Delaware	4,138	$67.45	$45.44	96
Nevada	3,933	$67.72	$44.43	146
Montana	3,112	$63.31	$41.57	97
Utah	3,035	$64.89	$43.23	112
Idaho	2,890	$57.67	$39.21	107
New Hampshire	2,857	$60.81	$40.01	99
New Mexico	2,833	$61.90	$38.74	92
South Dakota	2,391	$57.68	$39.39	60
Wyoming	2,012	$67.18	$42.76	62
Hawaii	1,986	$69.36	$42.77	55
Rhode Island	1,874	$68.45	$43.74	60
Alaska	1,656	$79.03	$40.68	57
District of Columbia	1,377	$76.90	$44.17	52
Vermont	1,288	$56.33	$37.95	47
Maine	1,250	$62.69	$40.62	48
North Dakota	1,201	$58.27	$39.10	51
Puerto Rico	789	$67.56	$43.32	30
U.S. Virgin Islands	200	$68.31	$42.57	5
Guam	73	$70.87	$34.27	4
Northern Mariana Islands	46	$72.05	$24.16	2

Related codes

99214Established patient office or other outpatient visit$117.48
99213Established patient office or other outpatient visit$83.92
99232Subsequent hospital care$76.07
99233Subsequent hospital care$115.58
99215Established patient office or other outpatient visit$163.65
99204New patient office or other outpatient visit$157.90
99223Initial hospital care$167.67
99285Emergency department visit$169.68
99203New patient office or other outpatient visit$104.03
99212Established patient office or other outpatient visit$52.42
99291Critical care$208.35
99222Initial hospital care$126.29

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.