How much does Medicare pay for CPT 99421?

Medicare allowed an average of $14.74 per service and paid $10.67 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $44.46, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99421?

Online digital evaluation and management service for an established patient for up to 7 days, total time 5-10 minutes. It was billed 57,399 times to 38,048 Medicare beneficiaries by 1,361 providers in 2024.

Does 99421 pay differently in an office than a hospital?

Yes. The allowed amount averaged $14.86 in an office setting and $13.12 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 99421 most?

Internal Medicine, with 21,143 services from 443 clinicians. Next are Family Practice, Nurse Practitioner, Endocrinology.

CPT 99421

Online digital evaluation and management service for an established patient for up to 7 days, total time 5-10 minutes

$14.74Medicare-allowed amount per service, averaged across 57,399 services

Providers submitted

$44.46

Asking price, not received

Medicare allowed

$14.74

The fee schedule figure

Medicare paid

$10.67

Balance is patient coinsurance

Providers submitted an average of $44.46 for this code and Medicare allowed $14.74 — 3.0× 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 $10.67 (72%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $14.86
Hospital / facility: $13.12

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. 53,193 services were billed in an office setting and 4,206 in a facility.

Services: 57,399
Beneficiaries: 38,048
Providers billing it: 1,361
Total allowed: $846,061

What Medicare pays for CPT 99421

Across 57,399 services billed by 1,361 providers to 38,048 beneficiaries, Medicare allowed an average of $14.74 per service. That is 1.5 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 99421

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	21,143	13,635	$15.59	443
Family Practice	10,077	7,306	$14.74	299
Nurse Practitioner	8,258	5,200	$12.17	173
Endocrinology	4,694	1,441	$15.08	60
Physician Assistant	2,408	2,000	$13.18	74
Cardiology	1,926	1,560	$15.22	52
Neurology	1,637	1,173	$15.12	43
Gastroenterology	1,088	856	$16.40	30
Rheumatology	683	544	$15.08	26
Pulmonary Disease	634	485	$15.29	18
Dermatology	628	550	$14.90	24
Urology	580	502	$15.61	19
Geriatric Medicine	471	360	$13.15	12
General Practice	383	267	$15.20	5
Interventional Cardiology	324	268	$15.60	7

99421 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	14,035	$15.61	$10.38	329
Texas	9,645	$14.50	$10.73	80
Washington	3,934	$14.65	$9.47	125
Illinois	3,526	$14.42	$9.17	107
Oklahoma	3,183	$12.73	$10.65	30
Nebraska	3,055	$11.82	$9.79	19
Ohio	2,809	$13.68	$9.44	119
Maryland	1,822	$27.81	$10.09	56
Florida	1,666	$14.21	$10.46	32
North Carolina	1,664	$13.25	$9.36	66
Tennessee	1,216	$13.12	$9.58	36
New York	1,199	$15.80	$10.27	35
Missouri	1,060	$12.79	$9.00	18
Minnesota	1,034	$14.11	$9.88	53
Virginia	846	$14.18	$10.05	29
Michigan	831	$13.05	$9.18	34
Louisiana	583	$12.72	$9.18	16
Oregon	563	$13.92	$9.04	22
New Jersey	550	$15.75	$10.06	6
Pennsylvania	466	$13.76	$9.41	21
Arizona	458	$13.16	$9.41	11
Indiana	442	$12.74	$7.91	16
Iowa	376	$12.50	$8.69	15
Mississippi	357	$12.91	$9.59	8
Colorado	233	$14.83	$10.53	4
Wisconsin	214	$12.88	$8.35	8
Georgia	209	$14.06	$10.50	11
South Carolina	161	$14.27	$10.64	9
Hawaii	155	$14.18	$10.60	4
Kentucky	151	$12.65	$8.40	7
District of Columbia	151	$16.73	$10.52	3
West Virginia	136	$12.51	$8.36	5
Massachusetts	104	$14.24	$10.59	4
New Mexico	104	$14.36	$9.38	5
Montana	88	$14.78	$10.67	3
Nevada	86	$14.15	$10.03	3
Connecticut	77	$15.26	$10.55	3
Alaska	76	$19.04	$10.34	4
Delaware	76	$14.77	$9.42	2
North Dakota	46	$11.59	$9.36	2
Wyoming	12	$12.37	$9.97	1

Related codes

99490Chronic care management services$59.70
99439Chronic care management services for two or more chronic conditions$46.13
99497Advance care planning$73.95
99457Management using the results of remote vital sign monitoring per calen$48.61
99458Management using the results of remote vital sign monitoring per calen$39.11
99454Remote monitoring of physiologic parameters$47.97
99489Complex chronic care management services for two or more chronic condi$67.00
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99487Complex chronic care management services for two or more chronic condi$124.70
99496Transitional care management services for problem of high complexity$252.87
99426Principal care management services for a single high-risk disease$60.08

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.