How much does Medicare pay for CPT 99235?

Medicare allowed an average of $154.94 per service and paid $119.10 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $444.66, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills 99235 most?

Internal Medicine, with 5,638 services from 239 clinicians. Next are Family Practice, Hospitalist, Nurse Practitioner.

CPT 99235

Initial hospital care with same-day admission and discharge with moderate level of medical decision making, per day, if using time, at least 70 minutes

$154.94Medicare-allowed amount per service, averaged across 14,417 services

Providers submitted

$444.66

Asking price, not received

Medicare allowed

$154.94

The fee schedule figure

Medicare paid

$119.10

Balance is patient coinsurance

Providers submitted an average of $444.66 for this code and Medicare allowed $154.94 — 2.9× 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 $119.10 (77%); the rest is the patient’s coinsurance and deductible.

Services: 14,417
Beneficiaries: 13,627
Providers billing it: 609
Total allowed: $2,233,770

What Medicare pays for CPT 99235

Across 14,417 services billed by 609 providers to 13,627 beneficiaries, Medicare allowed an average of $154.94 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 99235

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	5,638	5,397	$156.44	239
Family Practice	1,659	1,553	$156.75	74
Hospitalist	1,477	1,448	$159.96	91
Nurse Practitioner	1,392	1,311	$132.79	53
Clinical Cardiac Electrophysiology	653	610	$165.12	14
Emergency Medicine	584	580	$164.24	26
Cardiology	537	510	$160.90	24
Physician Assistant	414	413	$133.50	21
General Surgery	335	287	$161.54	10
Orthopedic Surgery	313	299	$151.32	3
Hematology-Oncology	248	198	$155.90	6
Gastroenterology	177	160	$150.63	3
Interventional Cardiology	164	158	$167.75	5
Nephrology	136	106	$158.50	7
Pulmonary Disease	131	117	$179.76	6

99235 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
Florida	2,469	$153.55	$116.45	85
Texas	1,479	$152.96	$118.45	51
California	1,097	$166.69	$117.18	41
New Jersey	978	$162.47	$113.78	40
New York	891	$171.79	$119.01	40
Illinois	861	$156.94	$115.95	41
Pennsylvania	618	$151.58	$115.48	26
Ohio	558	$148.88	$114.07	28
Arizona	557	$151.15	$122.29	10
Massachusetts	421	$153.16	$114.39	22
Indiana	346	$145.00	$116.53	13
Michigan	338	$156.59	$119.72	22
Maryland	321	$157.80	$115.77	9
Alabama	239	$145.27	$116.07	10
Delaware	233	$152.62	$115.01	9
Virginia	232	$158.81	$117.32	12
Georgia	219	$148.75	$117.06	11
Arkansas	198	$142.78	$116.43	13
Mississippi	184	$145.87	$117.08	12
Kentucky	181	$149.13	$114.31	9
Oregon	151	$153.29	$119.25	4
Utah	140	$138.77	$105.67	6
Louisiana	130	$146.89	$116.63	6
Tennessee	129	$143.55	$114.36	7
Connecticut	127	$164.30	$107.73	7
Nevada	123	$152.63	$118.71	8
Oklahoma	117	$147.60	$119.63	7
West Virginia	112	$151.62	$119.24	5
North Carolina	106	$150.72	$115.90	8
South Carolina	105	$141.85	$115.26	5
Colorado	101	$151.49	$119.49	4
Kansas	94	$137.60	$108.01	6
New Hampshire	87	$158.04	$120.49	5
Wisconsin	86	$141.46	$110.14	3
Missouri	61	$150.45	$111.52	4
Nebraska	60	$138.72	$105.26	4
Washington	53	$150.84	$106.36	3
Puerto Rico	42	$154.04	$94.04	2
Rhode Island	37	$158.04	$115.17	3
District of Columbia	33	$152.56	$123.44	1
Minnesota	22	$159.98	$122.18	1
Idaho	22	$151.67	$118.79	1
Iowa	12	$147.10	$123.44	1
South Dakota	12	$149.73	$109.44	1
Vermont	12	$152.91	$112.98	1
North Dakota	12	$151.47	$111.67	1
Hawaii	11	$132.01	$95.08	1

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.