How much does Medicare pay for CPT 99316?

Medicare allowed an average of $116.89 per service and paid $91.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $252.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99316?

Nursing facility discharge management, more than 30 minutes. It was billed 333,301 times to 314,663 Medicare beneficiaries by 6,848 providers in 2024.

Does 99316 pay differently in an office than a hospital?

Yes. The allowed amount averaged $118.55 in an office setting and $116.64 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 99316 most?

Nurse Practitioner, with 190,389 services from 3,932 clinicians. Next are Internal Medicine, Physician Assistant, Family Practice.

CPT 99316

Nursing facility discharge management, more than 30 minutes

$116.89Medicare-allowed amount per service, averaged across 333,301 services

Providers submitted

$252.03

Asking price, not received

Medicare allowed

$116.89

The fee schedule figure

Medicare paid

$91.46

Balance is patient coinsurance

Providers submitted an average of $252.03 for this code and Medicare allowed $116.89 — 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 $91.46 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $118.55
Hospital / facility: $116.64

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. 43,554 services were billed in an office setting and 289,747 in a facility.

Services: 333,301
Beneficiaries: 314,663
Providers billing it: 6,848
Total allowed: $38,959,554

What Medicare pays for CPT 99316

Across 333,301 services billed by 6,848 providers to 314,663 beneficiaries, Medicare allowed an average of $116.89 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 99316

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	190,389	180,768	$108.94	3,932
Internal Medicine	71,366	66,208	$132.15	1,316
Physician Assistant	25,370	24,142	$108.74	524
Family Practice	24,203	22,782	$129.08	578
Geriatric Medicine	8,125	7,695	$134.84	174
Hospitalist	7,748	7,350	$131.78	188
General Practice	1,476	1,367	$131.09	28
Physical Medicine and Rehabilitation	1,039	987	$130.03	20
Emergency Medicine	889	833	$131.82	24
Certified Clinical Nurse Specialist	599	567	$107.25	14
Pulmonary Disease	412	382	$132.48	6
Nephrology	389	341	$125.69	7
Critical Care (Intensivists)	198	187	$149.15	4
Osteopathic Manipulative Medicine	165	155	$131.10	4
Infectious Disease	122	117	$130.50	4

99316 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
New York	35,449	$129.96	$94.17	587
California	27,054	$130.68	$96.02	408
Florida	22,962	$117.10	$90.51	403
Massachusetts	16,810	$116.96	$87.44	283
New Jersey	16,662	$127.33	$93.07	311
Pennsylvania	16,586	$115.18	$90.13	405
Virginia	15,669	$112.58	$87.54	290
Maryland	13,768	$120.17	$90.27	246
North Carolina	12,641	$108.32	$87.18	272
Illinois	12,193	$117.33	$89.83	263
Michigan	10,360	$112.96	$88.39	226
Ohio	9,399	$110.30	$88.36	250
Tennessee	8,711	$104.16	$85.72	169
Texas	8,064	$115.00	$90.77	233
Connecticut	7,413	$115.83	$85.17	171
South Carolina	7,058	$107.79	$87.35	158
Minnesota	6,917	$108.40	$85.43	169
Washington	6,750	$114.06	$87.02	134
Arizona	6,160	$116.18	$94.27	110
Wisconsin	5,937	$108.20	$86.48	156
Indiana	5,629	$105.55	$85.61	142
Georgia	5,111	$111.35	$89.48	137
Nevada	4,807	$114.23	$92.08	72
Kansas	4,498	$105.47	$87.07	84
Colorado	3,699	$115.35	$88.14	100
Kentucky	3,538	$106.94	$86.79	94
Missouri	3,170	$111.20	$89.72	78
Oregon	2,817	$111.01	$86.00	67
Louisiana	2,517	$109.06	$89.74	88
Nebraska	2,491	$103.44	$84.83	46
Delaware	2,468	$111.73	$87.07	41
Idaho	2,433	$107.00	$87.39	45
New Hampshire	2,372	$111.70	$85.67	61
Iowa	2,256	$104.86	$85.07	65
Mississippi	2,165	$106.75	$87.90	57
Alabama	2,152	$109.13	$90.19	51
Oklahoma	1,968	$109.66	$90.26	49
Utah	1,958	$109.07	$86.97	30
West Virginia	1,480	$120.36	$95.65	29
Maine	1,337	$111.40	$87.49	45
Montana	1,155	$114.67	$87.98	35
Hawaii	1,025	$124.81	$95.36	28
North Dakota	940	$129.39	$96.15	14
New Mexico	831	$111.69	$88.72	24
Arkansas	786	$107.67	$89.36	29
District of Columbia	697	$128.65	$93.38	17
Vermont	646	$111.37	$88.55	20
South Dakota	624	$110.28	$87.62	21
Rhode Island	518	$113.11	$86.24	17
Wyoming	515	$109.74	$86.74	11
Alaska	87	$164.02	$100.96	6
AP	48	$105.85	$80.92	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
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.