How much does Medicare pay for CPT 99310?

Medicare allowed an average of $136.30 per service and paid $106.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $292.57, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99310?

Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes. It was billed 2,124,063 times to 926,260 Medicare beneficiaries by 13,634 providers in 2024.

Does 99310 pay differently in an office than a hospital?

Yes. The allowed amount averaged $135.66 in an office setting and $136.56 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 99310 most?

Nurse Practitioner, with 1,225,093 services from 8,027 clinicians. Next are Internal Medicine, Physician Assistant, Family Practice.

CPT 99310

Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes

$136.30Medicare-allowed amount per service, averaged across 2,124,063 services

Providers submitted

$292.57

Asking price, not received

Medicare allowed

$136.30

The fee schedule figure

Medicare paid

$106.17

Balance is patient coinsurance

Providers submitted an average of $292.57 for this code and Medicare allowed $136.30 — 2.1× 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 $106.17 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $135.66
Hospital / facility: $136.56

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 628,933 services were billed in an office setting and 1,495,130 in a facility.

Services: 2,124,063
Beneficiaries: 926,260
Providers billing it: 13,634
Total allowed: $289,509,787

What Medicare pays for CPT 99310

Across 2,124,063 services billed by 13,634 providers to 926,260 beneficiaries, Medicare allowed an average of $136.30 per service. That is 2.3 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 99310

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	1,225,093	578,175	$127.57	8,027
Internal Medicine	324,535	117,813	$152.37	1,975
Physician Assistant	165,561	72,537	$128.36	1,001
Family Practice	164,368	65,759	$150.22	1,121
Geriatric Medicine	37,435	15,683	$156.19	319
Hospitalist	30,619	12,394	$151.86	198
Pulmonary Disease	25,957	4,016	$158.67	81
Physical Medicine and Rehabilitation	21,359	11,045	$153.48	162
General Surgery	20,913	5,095	$159.15	92
Infectious Disease	13,681	4,097	$153.32	46
Emergency Medicine	12,572	3,926	$153.44	71
Psychiatry	11,923	5,610	$154.50	116
General Practice	11,770	4,260	$152.47	73
Certified Clinical Nurse Specialist	6,364	2,682	$125.87	41
Optometry	6,334	5,969	$150.64	38

99310 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	234,381	$151.60	$111.45	913
Florida	191,910	$137.34	$105.93	1,095
Texas	187,747	$132.81	$104.95	894
Pennsylvania	119,512	$134.49	$104.37	852
Illinois	107,054	$137.51	$104.63	708
New Jersey	104,918	$147.73	$107.10	611
Massachusetts	77,977	$138.77	$103.21	549
Maryland	67,129	$142.88	$105.25	415
New York	63,924	$147.32	$107.90	624
North Carolina	63,749	$127.13	$102.08	537
Virginia	56,464	$134.46	$103.64	459
South Carolina	56,025	$126.38	$102.17	291
Colorado	51,854	$138.73	$104.91	269
Arizona	45,885	$134.69	$108.50	240
Minnesota	44,557	$128.48	$100.56	339
Washington	44,405	$136.23	$102.82	259
Michigan	44,383	$134.87	$106.17	354
Indiana	38,494	$123.46	$101.16	288
Tennessee	35,671	$124.33	$102.13	280
Connecticut	35,338	$136.41	$101.21	310
Ohio	33,860	$128.99	$101.96	426
Wisconsin	32,763	$127.19	$101.87	236
Georgia	32,147	$130.78	$104.05	295
Utah	28,895	$133.64	$107.30	85
Missouri	27,442	$129.21	$103.55	211
Oklahoma	27,417	$129.88	$105.47	107
Louisiana	25,570	$128.00	$103.57	187
Nevada	22,405	$130.51	$103.86	101
Iowa	22,246	$122.37	$99.44	127
New Mexico	21,883	$129.95	$103.88	97
Kansas	17,926	$123.54	$101.82	142
Kentucky	15,313	$125.65	$101.22	174
Nebraska	14,353	$122.89	$98.99	74
Oregon	13,649	$130.86	$100.67	102
Alabama	13,633	$125.14	$102.72	153
Mississippi	12,420	$131.71	$105.91	89
New Hampshire	10,709	$131.58	$99.59	85
Maine	9,935	$131.10	$100.81	86
Idaho	9,112	$127.54	$104.02	58
Delaware	8,499	$133.06	$102.11	67
Arkansas	8,199	$121.99	$99.79	59
West Virginia	7,668	$132.58	$104.89	70
Hawaii	7,386	$150.11	$113.03	38
Rhode Island	7,349	$135.36	$102.64	67
District of Columbia	5,415	$146.06	$103.43	48
Montana	5,294	$138.52	$100.60	46
Wyoming	2,860	$132.41	$102.36	16
North Dakota	2,492	$129.44	$100.16	25
South Dakota	2,445	$125.63	$100.21	27
Vermont	1,831	$133.39	$103.22	26
Alaska	1,104	$155.49	$103.64	15
AP	253	$128.32	$100.25	2
Guam	65	$120.47	$98.02	1
XX	59	$136.00	$104.15	2
Puerto Rico	53	$149.39	$118.83	1
AE	19	$133.77	$101.24	1

Related codes

99309Subsequent nursing facility care$96.76
99308Subsequent nursing facility care$68.91
99349Residence visit for established patient$111.27
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.