How much does Medicare pay for CPT 99423?

Medicare allowed an average of $45.20 per service and paid $34.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $83.71, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99423?

Online digital evaluation and management service for an established patient for up to 7 days, total time 21 or more minutes. It was billed 40,717 times to 10,600 Medicare beneficiaries by 224 providers in 2024.

Does 99423 pay differently in an office than a hospital?

Yes. The allowed amount averaged $45.25 in an office setting and $40.66 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 99423 most?

Family Practice, with 24,405 services from 27 clinicians. Next are Internal Medicine, Nurse Practitioner, Cardiology.

CPT 99423

Online digital evaluation and management service for an established patient for up to 7 days, total time 21 or more minutes

$45.20Medicare-allowed amount per service, averaged across 40,717 services

Providers submitted

$83.71

Asking price, not received

Medicare allowed

$45.20

The fee schedule figure

Medicare paid

$34.84

Balance is patient coinsurance

Providers submitted an average of $83.71 for this code and Medicare allowed $45.20 — 1.9× 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 $34.84 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $45.25
Hospital / facility: $40.66

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. 40,196 services were billed in an office setting and 521 in a facility.

Services: 40,717
Beneficiaries: 10,600
Providers billing it: 224
Total allowed: $1,840,408

What Medicare pays for CPT 99423

Across 40,717 services billed by 224 providers to 10,600 beneficiaries, Medicare allowed an average of $45.20 per service. That is 3.8 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 99423

Specialty	Services	Beneficiaries	Avg allowed	Providers
Family Practice	24,405	3,101	$45.81	27
Internal Medicine	5,638	2,118	$44.98	49
Nurse Practitioner	2,284	1,299	$38.12	33
Cardiology	2,241	1,106	$46.62	22
Gastroenterology	1,618	385	$45.67	7
Neurology	965	613	$47.54	13
Physician Assistant	732	60	$37.99	2
General Practice	428	168	$46.62	4
Pulmonary Disease	387	182	$49.14	6
Nephrology	377	296	$42.36	14
Geriatric Medicine	199	155	$45.48	3
Orthopedic Surgery	160	136	$44.85	4
Urology	130	111	$44.99	4
Psychiatry	122	73	$35.02	2
Infectious Disease	96	67	$43.31	2

99423 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
Illinois	21,215	$45.87	$36.37	14
Texas	7,200	$43.27	$33.39	31
California	5,312	$47.20	$34.01	65
New York	1,568	$47.18	$33.08	10
Oklahoma	1,133	$39.82	$35.52	8
Florida	1,027	$45.08	$33.25	17
Louisiana	411	$42.07	$26.66	3
Nebraska	398	$36.69	$30.04	3
Virginia	320	$42.56	$33.28	11
Maryland	243	$49.60	$34.01	4
North Carolina	241	$44.75	$33.30	5
Tennessee	219	$42.21	$33.82	6
Michigan	217	$43.49	$32.12	6
Arizona	214	$44.43	$32.90	6
New Jersey	146	$47.14	$31.61	5
Missouri	120	$44.87	$32.36	1
Oregon	108	$42.15	$33.58	3
Kentucky	94	$36.82	$34.04	2
Pennsylvania	73	$47.20	$31.92	3
Georgia	68	$45.77	$36.00	3
Colorado	53	$40.61	$28.71	1
South Carolina	49	$38.23	$35.97	3
Minnesota	49	$38.27	$29.28	1
Mississippi	35	$36.39	$30.25	1
Ohio	34	$35.92	$28.63	2
Massachusetts	33	$45.56	$31.84	2
Washington	27	$46.44	$31.10	1
Nevada	26	$43.81	$23.59	2
Kansas	24	$39.83	$28.96	1
New Mexico	20	$44.46	$34.69	1
District of Columbia	14	$48.36	$36.54	1
Hawaii	13	$43.28	$33.93	1
Idaho	13	$43.17	$36.54	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.