How much does Medicare pay for CPT 99422?

Medicare allowed an average of $28.57 per service and paid $20.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $79.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99422?

Online digital evaluation and management service for an established patient for up to 7 days, total time 11-20 minutes. It was billed 23,903 times to 15,414 Medicare beneficiaries by 538 providers in 2024.

Does 99422 pay differently in an office than a hospital?

Yes. The allowed amount averaged $28.81 in an office setting and $25.63 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 99422 most?

Internal Medicine, with 10,389 services from 143 clinicians. Next are Family Practice, Nurse Practitioner, Cardiology.

CPT 99422

Online digital evaluation and management service for an established patient for up to 7 days, total time 11-20 minutes

$28.57Medicare-allowed amount per service, averaged across 23,903 services

Providers submitted

$79.20

Asking price, not received

Medicare allowed

$28.57

The fee schedule figure

Medicare paid

$20.84

Balance is patient coinsurance

Providers submitted an average of $79.20 for this code and Medicare allowed $28.57 — 2.8× 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 $20.84 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $28.81
Hospital / facility: $25.63

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. 22,085 services were billed in an office setting and 1,818 in a facility.

Services: 23,903
Beneficiaries: 15,414
Providers billing it: 538
Total allowed: $682,909

What Medicare pays for CPT 99422

Across 23,903 services billed by 538 providers to 15,414 beneficiaries, Medicare allowed an average of $28.57 per service. That is 1.6 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 99422

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	10,389	5,532	$29.04	143
Family Practice	3,490	2,643	$28.44	100
Nurse Practitioner	2,524	2,085	$23.79	90
Cardiology	1,787	1,380	$29.81	35
Neurology	1,320	756	$30.86	23
Endocrinology	637	264	$28.65	15
Physician Assistant	619	362	$25.48	21
Geriatric Medicine	346	247	$27.52	10
General Practice	341	143	$31.17	3
Gastroenterology	320	258	$30.14	13
Pain Management	287	193	$28.91	7
Dermatology	193	175	$29.16	11
Pulmonary Disease	145	116	$29.82	7
Hematology-Oncology	143	126	$30.36	7
Orthopedic Surgery	129	112	$29.55	3

99422 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	6,234	$30.09	$20.36	160
Texas	4,039	$28.08	$21.33	41
New York	1,922	$30.58	$20.26	29
Oklahoma	1,651	$25.03	$22.27	8
Illinois	1,333	$28.11	$19.43	38
Florida	1,072	$29.25	$20.80	25
Tennessee	936	$26.65	$19.22	15
Ohio	697	$25.71	$16.49	27
Arizona	685	$27.19	$19.07	15
Washington	625	$28.77	$19.22	24
North Carolina	577	$27.28	$19.92	22
Nebraska	534	$23.51	$20.31	13
Maryland	512	$38.96	$20.34	18
New Jersey	488	$30.59	$20.22	4
Louisiana	349	$25.07	$18.54	6
Michigan	274	$27.45	$20.00	12
Virginia	239	$30.03	$20.67	11
Minnesota	201	$25.57	$16.56	12
Colorado	198	$27.29	$18.51	5
Pennsylvania	176	$27.41	$20.49	7
Wisconsin	152	$24.68	$14.84	8
District of Columbia	117	$30.68	$21.26	4
South Carolina	99	$26.89	$18.90	4
Vermont	94	$28.91	$18.51	1
Mississippi	93	$24.32	$20.08	4
Nevada	90	$27.62	$20.49	3
Indiana	88	$24.78	$16.69	5
New Mexico	61	$27.97	$19.36	1
Alaska	51	$36.32	$21.81	2
Hawaii	50	$25.13	$14.47	2
Delaware	48	$28.59	$22.92	2
Missouri	45	$23.12	$17.21	3
Oregon	39	$28.06	$17.11	1
Massachusetts	37	$29.48	$15.69	1
Georgia	29	$28.37	$20.69	1
North Dakota	21	$20.28	$17.20	1
Kentucky	20	$28.66	$21.81	1
Iowa	16	$28.04	$20.61	1
Idaho	11	$20.15	$13.79	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.