How much does Medicare pay for CPT 99349?

Medicare allowed an average of $111.27 per service and paid $82.81 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $223.87, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99349?

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes. It was billed 3,553,733 times to 1,007,355 Medicare beneficiaries by 14,815 providers in 2024.

Does 99349 pay differently in an office than a hospital?

Yes. The allowed amount averaged $111.27 in an office setting and $122.41 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 99349 most?

Nurse Practitioner, with 2,307,091 services from 9,560 clinicians. Next are Internal Medicine, Physician Assistant, Family Practice.

CPT 99349

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes

$111.27Medicare-allowed amount per service, averaged across 3,553,733 services

Providers submitted

$223.87

Asking price, not received

Medicare allowed

$111.27

The fee schedule figure

Medicare paid

$82.81

Balance is patient coinsurance

Providers submitted an average of $223.87 for this code and Medicare allowed $111.27 — 2.0× 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 $82.81 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $111.27
Hospital / facility: $122.41

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,552,370 services were billed in an office setting and 1,363 in a facility.

Services: 3,553,733
Beneficiaries: 1,007,355
Providers billing it: 14,815
Total allowed: $395,423,871

What Medicare pays for CPT 99349

Across 3,553,733 services billed by 14,815 providers to 1,007,355 beneficiaries, Medicare allowed an average of $111.27 per service. That is 3.5 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 99349

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	2,307,091	621,842	$105.62	9,560
Internal Medicine	381,392	112,764	$127.60	1,570
Physician Assistant	288,743	80,624	$106.02	1,069
Family Practice	255,337	79,791	$124.86	1,179
Podiatry	91,236	39,042	$125.77	378
General Practice	51,167	11,021	$125.44	127
Geriatric Medicine	42,345	14,206	$126.44	283
Psychiatry	26,723	9,167	$128.97	138
Emergency Medicine	20,704	8,048	$124.64	105
Hospitalist	9,488	4,025	$125.98	55
Optometry	8,742	6,031	$124.77	37
General Surgery	7,176	1,277	$129.70	29
Cardiology	7,171	2,167	$129.35	24
Plastic and Reconstructive Surgery	6,856	990	$133.81	8
Certified Clinical Nurse Specialist	6,182	1,843	$106.29	41

99349 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	555,873	$111.63	$83.17	1,645
California	335,473	$119.43	$85.88	999
Texas	242,424	$108.56	$81.53	1,079
New York	221,635	$127.28	$86.08	807
North Carolina	192,466	$103.44	$80.51	606
Illinois	172,266	$117.20	$85.34	681
South Carolina	156,934	$103.46	$80.28	541
New Jersey	141,713	$118.59	$84.01	581
Virginia	128,150	$110.03	$81.34	517
Ohio	121,818	$103.66	$79.71	742
Pennsylvania	114,354	$112.55	$83.91	714
Michigan	108,061	$112.33	$82.25	520
Arizona	94,800	$107.48	$81.54	424
Maryland	86,780	$116.18	$81.22	362
Indiana	76,041	$102.64	$79.80	401
Tennessee	72,010	$103.07	$80.41	348
Minnesota	65,719	$106.86	$78.25	311
Colorado	63,817	$108.97	$80.63	271
Georgia	52,609	$108.25	$80.95	261
Nevada	47,322	$106.08	$81.51	192
Massachusetts	47,030	$112.10	$79.27	273
Washington	40,867	$112.55	$75.45	199
Oklahoma	39,174	$104.14	$81.68	149
Wisconsin	35,838	$105.21	$79.51	205
Kansas	32,021	$101.59	$79.11	133
Kentucky	31,187	$102.57	$78.75	178
Missouri	29,011	$106.14	$81.50	203
Connecticut	28,035	$114.57	$80.24	135
Utah	26,266	$103.52	$78.79	130
Idaho	22,803	$101.53	$78.91	81
Alabama	20,364	$97.92	$80.91	109
Mississippi	19,051	$100.44	$81.78	132
Arkansas	13,726	$103.08	$82.77	94
Iowa	12,697	$102.19	$79.08	92
Louisiana	11,947	$104.57	$78.51	104
Nebraska	11,695	$100.69	$78.64	48
Oregon	9,635	$112.42	$78.23	73
Delaware	8,717	$108.56	$82.64	49
New Hampshire	8,248	$108.95	$78.84	68
District of Columbia	7,210	$124.68	$83.77	33
West Virginia	6,955	$110.64	$82.51	47
North Dakota	6,138	$104.01	$76.34	30
Alaska	5,192	$140.09	$79.31	19
New Mexico	4,816	$105.23	$77.90	40
Montana	4,397	$102.22	$75.07	37
Hawaii	4,322	$113.99	$81.05	20
South Dakota	3,692	$103.94	$79.48	16
Maine	3,382	$112.22	$79.64	50
Rhode Island	3,308	$112.25	$81.83	33
Wyoming	2,753	$105.44	$76.43	13
Puerto Rico	1,948	$115.17	$90.94	8
Guam	634	$106.47	$76.22	3
AP	154	$140.89	$99.07	1
Vermont	137	$114.21	$75.10	5
U.S. Virgin Islands	42	$124.32	$96.56	1
XX	41	$105.30	$83.70	1

Related codes

99309Subsequent nursing facility care$96.76
99308Subsequent nursing facility care$68.91
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
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.