CPT 99231

Across 3,401,229 services billed by 44,310 providers to 1,525,381 beneficiaries, Medicare allowed an average of $46.98 per service. That is 2.2 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.

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.

• 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

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.

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