How much does Medicare pay for CPT 99315?

Medicare allowed an average of $75.31 per service and paid $58.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $161.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99315?

Nursing facility discharge day management, 30 minutes or less. It was billed 113,799 times to 105,708 Medicare beneficiaries by 2,651 providers in 2024.

Does 99315 pay differently in an office than a hospital?

Yes. The allowed amount averaged $77.19 in an office setting and $74.97 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 99315 most?

Nurse Practitioner, with 48,060 services from 1,205 clinicians. Next are Internal Medicine, Family Practice, Physician Assistant.

CPT 99315

Nursing facility discharge day management, 30 minutes or less

$75.31Medicare-allowed amount per service, averaged across 113,799 services

Providers submitted

$161.32

Asking price, not received

Medicare allowed

$75.31

The fee schedule figure

Medicare paid

$58.70

Balance is patient coinsurance

Providers submitted an average of $161.32 for this code and Medicare allowed $75.31 — 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 $58.70 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $77.19
Hospital / facility: $74.97

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 17,438 services were billed in an office setting and 96,361 in a facility.

Services: 113,799
Beneficiaries: 105,708
Providers billing it: 2,651
Total allowed: $8,570,203

What Medicare pays for CPT 99315

Across 113,799 services billed by 2,651 providers to 105,708 beneficiaries, Medicare allowed an average of $75.31 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 99315

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	48,060	45,378	$67.93	1,205
Internal Medicine	34,611	31,986	$83.01	670
Family Practice	16,979	15,080	$80.17	423
Physician Assistant	5,035	4,823	$66.57	134
Hospitalist	2,732	2,565	$79.89	63
Geriatric Medicine	2,161	1,983	$82.30	51
General Practice	1,514	1,367	$80.20	30
Physical Medicine and Rehabilitation	506	492	$79.58	15
Emergency Medicine	411	386	$77.20	20
Hospice and Palliative Care	335	307	$83.01	7
Nephrology	298	274	$80.77	8
Anesthesiology	298	251	$90.36	3
Thoracic Surgery	276	263	$76.31	2
Certified Clinical Nurse Specialist	152	148	$66.00	6
Neurology	72	72	$75.53	1

99315 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	14,191	$82.45	$60.83	184
New York	12,154	$83.11	$58.90	239
Florida	11,031	$75.62	$58.22	204
Pennsylvania	6,714	$74.24	$58.00	161
New Jersey	5,917	$80.73	$58.73	143
Massachusetts	5,601	$73.31	$55.44	116
Michigan	4,617	$70.95	$55.15	70
Maryland	4,337	$79.64	$59.18	78
North Carolina	3,991	$68.39	$54.53	113
Ohio	3,964	$71.87	$57.44	117
Texas	3,750	$72.92	$58.09	119
Illinois	3,517	$76.92	$58.36	90
Indiana	3,172	$66.17	$53.85	82
Virginia	2,533	$69.02	$53.56	77
Colorado	1,979	$72.76	$55.13	57
Georgia	1,920	$72.84	$58.00	54
Tennessee	1,904	$67.81	$55.43	60
Oklahoma	1,741	$66.86	$57.10	40
Kentucky	1,633	$69.60	$56.12	40
Alabama	1,362	$68.52	$56.81	36
Arizona	1,357	$71.40	$57.36	36
Mississippi	1,334	$66.56	$55.07	28
Missouri	1,319	$69.70	$56.71	35
Washington	1,230	$74.45	$55.65	39
Connecticut	1,141	$76.95	$56.03	38
Iowa	967	$68.07	$54.97	39
South Carolina	936	$75.12	$59.67	22
West Virginia	824	$73.12	$58.17	29
New Hampshire	745	$71.65	$54.68	14
Minnesota	735	$69.63	$54.08	30
Wisconsin	691	$69.17	$55.85	23
Nebraska	659	$65.64	$53.46	17
Nevada	625	$74.49	$59.86	18
Kansas	601	$69.66	$56.32	27
Louisiana	592	$70.35	$57.76	25
Arkansas	566	$70.50	$58.84	22
Rhode Island	522	$75.51	$56.56	14
Wyoming	418	$74.37	$56.34	15
South Dakota	413	$68.23	$53.41	11
North Dakota	410	$71.44	$55.02	16
Idaho	391	$67.37	$55.49	15
Utah	243	$70.70	$56.17	8
Oregon	203	$74.62	$56.58	10
Alaska	187	$98.92	$57.88	6
Vermont	168	$71.48	$55.81	7
Montana	148	$77.67	$58.44	8
Delaware	121	$71.87	$54.16	6
Hawaii	94	$82.83	$61.23	6
New Mexico	59	$69.23	$53.82	4
Maine	40	$64.56	$49.98	2
District of Columbia	32	$74.94	$53.91	1

Related codes

99309Subsequent nursing facility care$96.76
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

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.