How much does Medicare pay for CPT 99347?

Medicare allowed an average of $42.71 per service and paid $31.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $101.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99347?

Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes. It was billed 462,283 times to 197,388 Medicare beneficiaries by 3,859 providers in 2024.

Does 99347 pay differently in an office than a hospital?

Yes. The allowed amount averaged $42.71 in an office setting and $46.24 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 99347 most?

Podiatry, with 186,283 services from 1,092 clinicians. Next are Nurse Practitioner, Internal Medicine, Family Practice.

CPT 99347

Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes

$42.71Medicare-allowed amount per service, averaged across 462,283 services

Providers submitted

$101.01

Asking price, not received

Medicare allowed

$42.71

The fee schedule figure

Medicare paid

$31.01

Balance is patient coinsurance

Providers submitted an average of $101.01 for this code and Medicare allowed $42.71 — 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 $31.01 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $42.71
Hospital / facility: $46.24

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 462,127 services were billed in an office setting and 156 in a facility.

Services: 462,283
Beneficiaries: 197,388
Providers billing it: 3,859
Total allowed: $19,744,107

What Medicare pays for CPT 99347

Across 462,283 services billed by 3,859 providers to 197,388 beneficiaries, Medicare allowed an average of $42.71 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 99347

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	186,283	94,736	$45.27	1,092
Nurse Practitioner	147,679	59,421	$37.90	1,689
Internal Medicine	39,890	13,044	$46.05	336
Family Practice	26,101	8,995	$44.49	243
Psychiatry	20,265	4,515	$46.07	77
Physician Assistant	17,810	8,008	$38.13	203
Geriatric Psychiatry	7,208	1,078	$46.17	7
General Practice	3,580	1,279	$45.50	31
Geriatric Medicine	3,460	1,872	$45.53	54
Emergency Medicine	1,886	1,054	$43.92	24
General Surgery	1,303	485	$47.09	19
Physical Medicine and Rehabilitation	942	200	$47.05	4
Pulmonary Disease	844	247	$45.39	7
Hospitalist	731	281	$44.86	12
Cardiology	650	217	$47.00	3

99347 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	68,359	$41.96	$30.58	421
New York	65,815	$47.72	$32.83	335
California	51,121	$43.99	$30.74	333
Texas	30,960	$40.50	$29.60	204
Illinois	30,015	$44.60	$31.11	170
New Jersey	24,391	$46.12	$31.89	224
Pennsylvania	20,683	$42.88	$30.82	198
Michigan	17,163	$42.92	$30.30	177
Ohio	14,212	$39.82	$29.28	161
Virginia	12,392	$41.07	$28.96	145
Oklahoma	11,673	$40.14	$30.59	59
North Carolina	10,895	$37.69	$27.79	111
Maryland	7,933	$42.71	$29.49	101
Missouri	7,686	$38.32	$27.39	83
Massachusetts	7,118	$43.70	$29.55	88
Indiana	6,918	$37.73	$28.76	80
Colorado	6,870	$38.53	$27.38	95
South Carolina	6,377	$39.75	$30.09	68
Washington	6,351	$42.89	$30.02	51
Arizona	5,882	$39.97	$30.24	75
Wisconsin	5,481	$41.82	$29.30	47
Tennessee	4,917	$36.69	$27.30	62
Georgia	4,662	$40.96	$27.77	45
Mississippi	3,417	$37.43	$30.19	45
Kansas	3,414	$36.74	$26.48	52
Utah	2,865	$39.47	$29.39	36
Kentucky	2,624	$38.04	$28.77	37
Connecticut	2,452	$42.54	$29.39	39
Minnesota	2,287	$38.99	$27.57	54
New Hampshire	2,112	$40.94	$29.09	24
Nevada	1,892	$41.96	$29.30	17
Alabama	1,783	$37.63	$29.03	25
Iowa	1,621	$40.90	$29.03	30
Maine	1,472	$39.49	$27.41	22
Oregon	999	$41.47	$25.98	19
New Mexico	887	$43.90	$30.95	10
West Virginia	876	$37.08	$27.83	6
Arkansas	776	$36.33	$28.10	17
Nebraska	653	$37.88	$29.18	9
Delaware	587	$42.61	$30.72	11
Puerto Rico	566	$44.06	$32.39	8
South Dakota	558	$41.81	$25.19	4
Rhode Island	516	$42.15	$27.55	10
Louisiana	479	$39.52	$27.52	15
District of Columbia	340	$41.97	$27.97	6
Wyoming	295	$38.75	$26.35	3
Montana	245	$41.34	$25.87	5
Idaho	243	$37.00	$28.26	12
U.S. Virgin Islands	221	$44.21	$35.18	1
Hawaii	80	$42.93	$26.11	2
Alaska	68	$53.33	$29.60	3
Vermont	62	$43.31	$29.81	3
North Dakota	19	$36.84	$26.71	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
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.