How much does Medicare pay for CPT 99309?

Medicare allowed an average of $96.76 per service and paid $74.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $210.68, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99309?

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes. It was billed 14,712,800 times to 3,655,559 Medicare beneficiaries by 30,091 providers in 2024.

Does 99309 pay differently in an office than a hospital?

Yes. The allowed amount averaged $95.21 in an office setting and $97.63 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 99309 most?

Nurse Practitioner, with 8,127,388 services from 15,522 clinicians. Next are Internal Medicine, Family Practice, Physician Assistant.

CPT 99309

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes

$96.76Medicare-allowed amount per service, averaged across 14,712,800 services

Providers submitted

$210.68

Asking price, not received

Medicare allowed

$96.76

The fee schedule figure

Medicare paid

$74.88

Balance is patient coinsurance

Providers submitted an average of $210.68 for this code and Medicare allowed $96.76 — 2.2× 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 $74.88 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $95.21
Hospital / facility: $97.63

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 5,341,759 services were billed in an office setting and 9,371,041 in a facility.

Services: 14,712,800
Beneficiaries: 3,655,559
Providers billing it: 30,091
Total allowed: $1,423,610,528

What Medicare pays for CPT 99309

Across 14,712,800 services billed by 30,091 providers to 3,655,559 beneficiaries, Medicare allowed an average of $96.76 per service. That is 4.0 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 99309

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	8,127,388	1,964,255	$89.90	15,522
Internal Medicine	2,351,412	564,884	$108.38	5,091
Family Practice	1,192,109	332,963	$105.84	3,286
Physician Assistant	1,069,367	264,608	$91.01	2,060
Physical Medicine and Rehabilitation	635,077	126,194	$110.11	667
Geriatric Medicine	186,265	52,138	$106.94	573
Hospitalist	166,308	47,210	$106.63	487
General Practice	146,574	35,562	$107.47	226
Psychiatry	133,498	50,929	$108.40	358
General Surgery	119,632	34,979	$111.58	212
Emergency Medicine	71,596	20,932	$104.67	169
Pulmonary Disease	66,038	13,448	$112.94	183
Pain Management	40,224	5,943	$109.39	34
Infectious Disease	38,295	11,643	$109.24	115
Cardiology	37,168	10,318	$114.00	99

99309 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	1,737,401	$95.86	$74.03	2,522
California	1,414,541	$106.22	$77.20	1,967
New York	1,296,063	$107.26	$75.86	2,272
Texas	1,003,844	$93.35	$73.61	1,932
New Jersey	786,004	$105.46	$75.71	1,469
Pennsylvania	739,713	$96.55	$74.14	1,751
Illinois	681,516	$97.45	$73.67	1,487
Ohio	528,819	$90.14	$70.94	1,482
Maryland	523,051	$99.76	$73.42	841
Massachusetts	490,137	$97.92	$71.96	896
North Carolina	462,863	$89.91	$71.15	988
Virginia	457,253	$93.64	$72.04	870
Indiana	406,101	$87.79	$70.60	785
Georgia	352,980	$92.12	$72.45	631
Tennessee	315,061	$86.86	$70.56	676
Michigan	260,158	$94.57	$72.45	859
Connecticut	257,567	$97.30	$71.15	591
Missouri	229,357	$91.94	$72.48	547
South Carolina	228,952	$89.76	$71.31	485
Louisiana	226,756	$89.24	$70.81	392
Arizona	226,618	$94.35	$75.76	474
Kentucky	199,516	$89.44	$71.87	472
Colorado	171,638	$96.18	$72.57	393
Oklahoma	156,558	$92.02	$75.04	300
Washington	140,232	$96.32	$71.84	407
Nevada	131,121	$93.61	$74.30	240
Alabama	129,551	$88.21	$71.54	360
Kansas	114,509	$88.33	$70.95	327
Wisconsin	92,972	$91.15	$71.92	406
Minnesota	83,200	$93.56	$71.22	530
Arkansas	82,418	$86.94	$70.47	208
Delaware	81,799	$93.66	$72.09	114
Iowa	78,769	$88.16	$68.46	315
Utah	74,881	$92.72	$73.60	147
Mississippi	67,332	$89.94	$73.16	239
West Virginia	62,875	$94.74	$73.79	190
New Hampshire	61,729	$94.17	$70.53	170
New Mexico	52,865	$89.11	$70.84	142
Rhode Island	46,881	$94.57	$71.72	130
Maine	39,202	$92.02	$70.90	136
Nebraska	38,430	$87.93	$70.90	161
District of Columbia	35,937	$104.05	$74.93	72
Idaho	34,642	$89.49	$72.22	105
Oregon	26,389	$92.19	$69.80	152
North Dakota	17,950	$96.07	$69.39	92
Hawaii	16,603	$103.23	$76.33	65
South Dakota	14,205	$91.26	$69.39	80
Wyoming	8,917	$96.09	$72.77	47
Vermont	8,480	$92.63	$71.65	51
Montana	7,263	$99.05	$71.81	70
Alaska	5,575	$113.35	$72.61	41
Puerto Rico	2,349	$105.93	$83.49	2
AP	1,120	$87.61	$65.74	2
AE	954	$93.97	$70.69	1
XX	621	$98.89	$76.29	2
Guam	308	$98.87	$72.25	3

Related codes

99308Subsequent nursing facility care$68.91
99349Residence visit for established patient$111.27
99310Subsequent nursing facility care$136.30
99348Residence visit for established patient$69.57
99307Subsequent nursing facility care$38.21
99306Initial nursing facility care$173.94
99350Residence visit for established patient$162.36
99305Initial nursing facility care$126.36
99347Residence visit for established patient$42.71
99316Nursing facility discharge management$116.89
99304Initial nursing facility care$76.99
99344Residence visit for new patient$127.50

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.