How much does Medicare pay for CPT 99342?

Medicare allowed an average of $74.19 per service and paid $54.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $180.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99342?

Residence visit for new patient with low level of medical decision making, per day, if using time, at least 30 minutes. It was billed 131,961 times to 131,897 Medicare beneficiaries by 2,433 providers in 2024.

Does 99342 pay differently in an office than a hospital?

Yes. The allowed amount averaged $74.18 in an office setting and $80.43 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 99342 most?

Podiatry, with 81,268 services from 1,087 clinicians. Next are Nurse Practitioner, Physician Assistant, Internal Medicine.

CPT 99342

Residence visit for new patient with low level of medical decision making, per day, if using time, at least 30 minutes

$74.19Medicare-allowed amount per service, averaged across 131,961 services

Providers submitted

$180.40

Asking price, not received

Medicare allowed

$74.19

The fee schedule figure

Medicare paid

$54.70

Balance is patient coinsurance

Providers submitted an average of $180.40 for this code and Medicare allowed $74.19 — 2.4× 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 $54.70 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $74.18
Hospital / facility: $80.43

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 131,825 services were billed in an office setting and 136 in a facility.

Services: 131,961
Beneficiaries: 131,897
Providers billing it: 2,433
Total allowed: $9,790,187

What Medicare pays for CPT 99342

Across 131,961 services billed by 2,433 providers to 131,897 beneficiaries, Medicare allowed an average of $74.19 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 99342

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	81,268	81,240	$77.74	1,087
Nurse Practitioner	30,577	30,557	$66.11	827
Physician Assistant	11,372	11,370	$67.15	251
Internal Medicine	2,290	2,285	$79.03	82
Family Practice	1,522	1,515	$76.42	58
Emergency Medicine	1,252	1,250	$76.77	31
General Surgery	514	514	$79.38	13
General Practice	511	511	$79.58	9
Psychiatry	436	436	$76.82	15
Osteopathic Manipulative Medicine	290	290	$81.15	1
Cardiology	280	280	$84.55	7
Nephrology	224	224	$82.28	2
Plastic and Reconstructive Surgery	205	205	$79.31	4
Physical Medicine and Rehabilitation	198	198	$83.19	6
Geriatric Medicine	179	179	$77.67	8

99342 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	24,250	$75.37	$52.57	347
Florida	17,898	$73.11	$53.74	339
New York	12,635	$81.92	$57.08	204
Texas	8,993	$71.96	$54.06	156
Illinois	7,998	$76.17	$54.23	135
New Jersey	6,176	$78.90	$56.14	129
Michigan	5,627	$75.22	$55.49	112
Arizona	5,088	$69.91	$53.86	84
Pennsylvania	4,691	$73.81	$55.29	103
Virginia	4,346	$72.33	$52.15	69
Ohio	3,393	$70.62	$53.15	90
Washington	3,133	$72.15	$49.97	64
Maryland	2,972	$76.66	$55.63	54
Massachusetts	2,250	$75.88	$53.70	35
Colorado	2,016	$67.86	$48.33	52
North Carolina	1,806	$69.53	$50.92	23
Nevada	1,752	$66.58	$49.19	38
Georgia	1,602	$72.71	$51.51	26
Minnesota	1,339	$73.40	$50.86	20
Indiana	1,320	$69.27	$53.26	29
Missouri	1,237	$69.01	$51.01	31
South Carolina	1,111	$72.09	$53.43	18
Utah	1,053	$71.26	$52.35	19
Oklahoma	998	$67.15	$51.77	27
Tennessee	833	$66.45	$48.89	24
Oregon	772	$74.49	$52.78	10
Connecticut	666	$77.49	$55.85	15
Kentucky	650	$70.21	$54.08	11
Mississippi	615	$60.38	$47.85	29
Arkansas	582	$64.97	$50.77	17
New Hampshire	516	$71.91	$51.82	10
Delaware	404	$75.36	$55.76	9
Louisiana	383	$69.07	$51.90	12
Kansas	367	$65.91	$49.72	14
Iowa	357	$73.32	$52.70	8
District of Columbia	353	$72.45	$49.74	9
Alabama	338	$67.46	$52.71	13
Rhode Island	308	$74.46	$50.11	9
Wisconsin	235	$70.08	$54.50	8
Idaho	234	$66.40	$46.78	9
Maine	189	$74.92	$52.40	3
West Virginia	114	$66.12	$51.38	6
Montana	84	$68.70	$49.06	4
Nebraska	73	$63.29	$52.21	3
New Mexico	72	$65.59	$46.42	2
AE	68	$64.11	$43.06	1
Puerto Rico	32	$76.37	$56.95	1
North Dakota	16	$78.00	$59.78	1
Hawaii	16	$72.13	$60.50	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.