How much does Medicare pay for CPT 99239?

Medicare allowed an average of $110.50 per service and paid $87.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $353.96, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99239?

Hospital discharge day management, more than 30 minutes. It was billed 5,221,363 times to 4,986,727 Medicare beneficiaries by 64,431 providers in 2024.

Does 99239 pay differently in an office than a hospital?

Yes. The allowed amount averaged $107.40 in an office setting and $110.51 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 99239 most?

Internal Medicine, with 2,524,481 services from 26,374 clinicians. Next are Hospitalist, Family Practice, Nurse Practitioner.

CPT 99239

Hospital discharge day management, more than 30 minutes

$110.50Medicare-allowed amount per service, averaged across 5,221,363 services

Providers submitted

$353.96

Asking price, not received

Medicare allowed

$110.50

The fee schedule figure

Medicare paid

$87.11

Balance is patient coinsurance

Providers submitted an average of $353.96 for this code and Medicare allowed $110.50 — 3.2× 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 $87.11 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $107.40
Hospital / facility: $110.51

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 6,282 services were billed in an office setting and 5,215,081 in a facility.

Services: 5,221,363
Beneficiaries: 4,986,727
Providers billing it: 64,431
Total allowed: $576,960,612

What Medicare pays for CPT 99239

Across 5,221,363 services billed by 64,431 providers to 4,986,727 beneficiaries, Medicare allowed an average of $110.50 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 99239

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	2,524,481	2,401,455	$111.98	26,374
Hospitalist	1,385,717	1,341,364	$112.64	14,219
Family Practice	459,001	431,318	$110.61	5,819
Nurse Practitioner	288,529	277,712	$93.99	5,870
Physical Medicine and Rehabilitation	156,270	147,981	$110.79	1,518
Physician Assistant	147,826	143,839	$94.49	3,299
Psychiatry	55,805	50,245	$111.21	1,694
Emergency Medicine	33,963	32,437	$111.01	583
Cardiology	25,621	24,626	$113.76	993
Nephrology	15,553	14,201	$112.30	286
General Surgery	14,137	13,771	$112.03	533
Pulmonary Disease	13,223	12,040	$110.86	415
Neurology	11,621	11,375	$113.37	395
Interventional Cardiology	10,158	9,917	$111.59	382
General Practice	10,004	9,120	$110.47	109

99239 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	478,843	$118.23	$87.15	5,251
Florida	458,271	$111.60	$86.63	4,397
Texas	391,294	$108.67	$86.62	4,326
New York	262,894	$118.21	$86.61	3,546
Pennsylvania	256,629	$108.57	$85.70	3,381
Illinois	249,587	$113.01	$86.87	2,752
Ohio	204,633	$106.27	$85.81	2,821
New Jersey	178,531	$118.13	$86.73	1,756
Massachusetts	160,683	$114.10	$85.68	2,125
Virginia	157,463	$110.51	$86.23	1,625
North Carolina	155,548	$105.63	$85.44	2,431
Georgia	150,094	$108.17	$86.67	1,984
Michigan	147,321	$110.30	$86.60	2,281
Arizona	122,425	$108.21	$86.67	1,257
Maryland	120,576	$113.45	$85.40	1,186
Missouri	117,370	$106.80	$86.43	1,400
Indiana	116,310	$105.11	$86.58	1,336
Tennessee	107,186	$104.06	$86.31	1,304
South Carolina	94,000	$106.16	$86.21	1,108
Kentucky	86,302	$106.48	$85.98	1,032
Wisconsin	81,127	$105.07	$85.99	1,373
Washington	79,286	$112.57	$86.05	1,284
Louisiana	73,485	$106.15	$86.61	981
Oklahoma	73,217	$105.59	$86.40	732
Minnesota	73,067	$106.43	$85.24	1,612
Nevada	66,442	$109.28	$86.98	553
Colorado	62,079	$110.84	$86.17	997
Alabama	61,095	$104.13	$87.18	803
Mississippi	59,380	$102.96	$85.36	547
Connecticut	57,077	$116.05	$86.14	809
Arkansas	52,474	$103.01	$86.94	531
Kansas	49,628	$105.11	$86.68	556
Oregon	46,167	$110.49	$85.89	875
Iowa	42,707	$103.54	$85.50	672
Nebraska	31,633	$104.20	$86.52	477
New Hampshire	31,048	$110.41	$85.85	382
West Virginia	30,599	$108.21	$86.30	373
Delaware	23,697	$110.17	$86.18	264
New Mexico	22,744	$106.23	$84.72	344
Maine	21,756	$108.96	$85.85	456
Utah	20,462	$106.08	$85.21	388
Idaho	19,890	$104.29	$86.25	312
District of Columbia	18,991	$118.77	$87.22	250
Montana	18,619	$108.74	$85.06	272
North Dakota	17,885	$107.63	$86.37	215
Rhode Island	16,373	$112.30	$85.51	277
South Dakota	13,657	$106.24	$86.16	209
Hawaii	13,341	$112.96	$87.04	194
Vermont	9,005	$107.48	$85.55	136
Alaska	7,680	$143.39	$86.36	109
Wyoming	6,960	$106.39	$83.78	90
Puerto Rico	1,826	$110.11	$87.53	30
Guam	935	$110.53	$82.48	16
ZZ	540	$110.42	$87.31	4
AP	198	$124.19	$88.54	2
AA	181	$109.99	$88.03	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.