How much does Medicare pay for CPT 99214?

Medicare allowed an average of $117.48 per service and paid $82.34 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $274.84, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99214?

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more. It was billed 102,377,857 times to 59,916,091 Medicare beneficiaries by 498,045 providers in 2024.

Does 99214 pay differently in an office than a hospital?

Yes. The allowed amount averaged $119.77 in an office setting and $90.32 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 99214 most?

Family Practice, with 15,314,300 services from 61,370 clinicians. Next are Internal Medicine, Nurse Practitioner, Cardiology.

CPT 99214

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more

$117.48Medicare-allowed amount per service, averaged across 102,377,857 services

Providers submitted

$274.84

Asking price, not received

Medicare allowed

$117.48

The fee schedule figure

Medicare paid

$82.34

Balance is patient coinsurance

Providers submitted an average of $274.84 for this code and Medicare allowed $117.48 — 2.3× 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 $82.34 (70%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $119.77
Hospital / facility: $90.32

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. 94,408,288 services were billed in an office setting and 7,969,569 in a facility.

Services: 102,377,857
Beneficiaries: 59,916,091
Providers billing it: 498,045
Total allowed: $12,027,350,640

What Medicare pays for CPT 99214

Across 102,377,857 services billed by 498,045 providers to 59,916,091 beneficiaries, Medicare allowed an average of $117.48 per service. That is 1.7 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 99214

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	15,314,300	7,882,910	$119.04	61,370
Internal Medicine	14,775,737	7,334,537	$121.45	48,367
Nurse Practitioner	14,493,156	9,001,125	$99.34	102,346
Cardiology	7,910,722	4,808,275	$125.35	16,782
Physician Assistant	6,794,354	4,704,768	$101.68	54,916
Ophthalmology	3,428,478	2,477,650	$125.96	11,591
Hematology-Oncology	3,072,423	1,362,816	$116.80	8,025
Urology	2,961,698	1,986,786	$125.85	8,297
Orthopedic Surgery	2,787,536	2,032,515	$124.69	17,415
Dermatology	2,261,337	1,628,592	$127.09	10,345
Endocrinology	2,165,301	1,235,509	$124.55	5,835
Neurology	2,016,773	1,291,228	$122.97	10,573
Pulmonary Disease	1,975,946	1,210,974	$123.05	7,904
Nephrology	1,888,087	1,052,511	$115.46	7,626
Rheumatology	1,881,494	939,628	$123.69	4,719

99214 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	10,010,320	$130.33	$87.03	39,670
Florida	9,649,855	$121.26	$86.83	34,332
Texas	7,267,461	$116.98	$84.44	34,254
New York	6,175,119	$131.66	$86.47	31,514
Pennsylvania	4,268,181	$116.52	$82.83	23,928
Illinois	3,817,561	$119.64	$82.70	19,137
New Jersey	3,601,814	$131.24	$88.34	14,316
North Carolina	3,505,738	$111.44	$81.10	18,704
Virginia	3,373,571	$117.62	$81.90	13,484
Ohio	3,313,728	$105.88	$78.74	20,546
Georgia	3,063,744	$116.33	$84.27	14,423
Maryland	3,002,198	$120.27	$85.35	10,691
Massachusetts	2,943,274	$119.11	$80.92	15,837
Arizona	2,679,338	$117.00	$85.27	10,888
Tennessee	2,545,469	$109.12	$82.55	11,774
South Carolina	2,504,011	$113.75	$84.08	8,578
Michigan	2,272,988	$111.76	$81.18	15,653
Indiana	2,150,954	$111.41	$82.11	10,816
Washington	1,743,957	$118.81	$79.69	11,083
Missouri	1,645,485	$107.37	$79.39	9,243
Alabama	1,578,127	$108.68	$84.19	7,517
Oklahoma	1,446,859	$106.53	$81.06	5,827
Louisiana	1,402,575	$109.62	$82.47	6,877
Kentucky	1,392,122	$108.50	$80.54	7,388
Wisconsin	1,249,161	$107.16	$77.03	10,137
Mississippi	1,236,025	$106.05	$80.72	4,188
Colorado	1,234,094	$113.80	$82.82	8,533
Arkansas	1,172,096	$102.68	$81.04	4,441
Minnesota	1,093,486	$111.40	$78.82	10,516
Connecticut	1,030,272	$125.93	$83.80	6,765
Kansas	997,169	$105.96	$80.54	4,457
Iowa	954,046	$105.24	$78.20	4,805
Oregon	872,419	$111.92	$80.01	6,292
Nevada	849,505	$116.87	$85.00	3,834
Nebraska	667,816	$105.13	$81.48	3,315
Utah	639,773	$112.14	$81.83	4,377
Delaware	582,076	$116.71	$83.94	1,917
New Hampshire	566,797	$108.46	$75.78	3,194
New Mexico	477,606	$107.23	$77.90	2,773
West Virginia	435,295	$102.74	$74.25	2,775
Idaho	411,366	$99.58	$74.04	2,811
Montana	329,095	$102.27	$74.09	1,858
Rhode Island	288,668	$114.31	$83.02	2,041
Hawaii	287,316	$117.15	$83.28	1,517
Maine	282,555	$96.34	$71.20	2,608
South Dakota	281,880	$98.97	$71.97	1,664
North Dakota	247,808	$95.61	$69.96	1,518
District of Columbia	229,809	$132.72	$85.78	1,413
Alaska	207,753	$143.25	$79.98	1,296
Vermont	156,688	$101.13	$72.22	990
Wyoming	153,714	$114.73	$81.23	809
Puerto Rico	37,370	$120.02	$87.33	478
Guam	25,193	$125.66	$80.24	103
U.S. Virgin Islands	16,240	$120.78	$78.03	79
XX	3,329	$128.72	$91.76	10
AE	2,363	$125.85	$86.28	16

Related codes

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
99239Hospital discharge day management$110.50

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.