How much does Medicare pay for CPT 99211?

Medicare allowed an average of $22.37 per service and paid $16.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $59.34, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99211 pay differently in an office than a hospital?

Yes. The allowed amount averaged $23.00 in an office setting and $8.73 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 99211 most?

Family Practice, with 206,935 services from 2,926 clinicians. Next are Internal Medicine, Cardiology, Nurse Practitioner.

CPT 99211

Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional

$22.37Medicare-allowed amount per service, averaged across 962,003 services

Providers submitted

$59.34

Asking price, not received

Medicare allowed

$22.37

The fee schedule figure

Medicare paid

$16.05

Balance is patient coinsurance

Providers submitted an average of $59.34 for this code and Medicare allowed $22.37 — 2.7× 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 $16.05 (72%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $23.00
Hospital / facility: $8.73

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. 919,769 services were billed in an office setting and 42,234 in a facility.

Services: 962,003
Beneficiaries: 488,365
Providers billing it: 13,851
Total allowed: $21,520,007

What Medicare pays for CPT 99211

Across 962,003 services billed by 13,851 providers to 488,365 beneficiaries, Medicare allowed an average of $22.37 per service. That is 2.0 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 99211

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	206,935	98,532	$22.79	2,926
Internal Medicine	206,159	100,335	$24.04	2,658
Cardiology	106,233	50,205	$21.99	1,200
Nurse Practitioner	91,205	46,248	$18.64	1,556
Urology	54,817	33,776	$22.78	1,021
Hematology-Oncology	29,766	16,647	$21.99	528
Physician Assistant	23,703	14,066	$19.28	567
General Practice	20,836	6,905	$24.97	117
Interventional Cardiology	15,583	7,660	$22.54	244
Psychiatry	15,045	4,835	$17.96	162
Allergy/ Immunology	12,670	2,399	$25.20	104
Dermatology	12,139	8,225	$23.75	225
Ophthalmology	11,214	8,909	$22.88	174
Endocrinology	10,504	6,684	$22.22	205
Podiatry	10,287	6,410	$23.19	164

99211 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	165,841	$23.48	$15.65	1,432
Florida	112,389	$22.29	$15.77	1,451
Arizona	46,632	$21.85	$15.93	472
Texas	44,574	$21.69	$15.60	783
New York	36,553	$24.34	$15.73	585
North Carolina	35,589	$20.95	$15.48	640
Illinois	34,391	$22.13	$15.65	546
Georgia	28,590	$21.35	$15.74	437
Pennsylvania	28,061	$21.92	$15.85	479
Washington	27,733	$23.31	$15.11	489
Virginia	23,487	$21.72	$14.93	437
New Jersey	23,288	$25.56	$15.73	350
Maryland	22,572	$28.44	$15.90	278
Ohio	22,360	$21.49	$14.86	431
Indiana	19,604	$19.94	$14.81	437
Tennessee	18,486	$20.58	$16.03	274
Nevada	18,405	$21.49	$15.94	125
South Carolina	18,367	$20.63	$15.45	324
Kansas	18,191	$20.23	$15.58	170
Massachusetts	16,956	$24.21	$15.10	302
Oregon	16,813	$25.40	$14.56	218
Minnesota	16,653	$21.72	$14.84	369
Louisiana	14,501	$19.84	$15.67	168
Michigan	11,338	$22.50	$15.41	220
Iowa	11,262	$18.90	$14.12	129
Kentucky	10,810	$19.54	$14.75	148
Wisconsin	9,324	$20.49	$14.42	201
Arkansas	9,280	$19.70	$14.58	146
Mississippi	8,553	$18.17	$13.98	141
Colorado	7,798	$24.85	$15.95	176
Oklahoma	7,449	$20.25	$15.08	131
New Hampshire	7,141	$19.83	$13.13	139
Delaware	6,692	$23.19	$16.37	94
Alabama	5,914	$18.90	$15.20	124
Nebraska	5,720	$23.06	$15.32	90
Missouri	5,312	$19.83	$15.33	108
Connecticut	5,225	$23.80	$15.67	125
New Mexico	4,852	$18.88	$14.29	78
Montana	4,585	$27.89	$12.09	58
Alaska	4,322	$24.66	$14.59	90
Wyoming	4,062	$21.34	$14.52	60
Utah	3,178	$20.62	$15.37	55
Hawaii	2,426	$25.21	$16.58	34
West Virginia	2,195	$19.13	$14.50	32
Puerto Rico	1,968	$22.76	$14.94	35
Idaho	1,958	$20.94	$15.61	39
Vermont	1,908	$19.20	$12.85	41
District of Columbia	1,884	$24.47	$15.41	35
North Dakota	1,817	$22.67	$14.95	24
South Dakota	1,264	$21.33	$14.60	21
Maine	1,110	$31.59	$14.52	28
Guam	1,096	$23.63	$15.75	10
Rhode Island	892	$23.91	$16.44	34
Northern Mariana Islands	471	$21.78	$12.70	3
U.S. Virgin Islands	161	$22.26	$15.74	5

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.