How much does Medicare pay for CPT 99427?

Medicare allowed an average of $45.31 per service and paid $35.81 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $110.36, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99427 pay differently in an office than a hospital?

Yes. The allowed amount averaged $45.50 in an office setting and $33.21 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 99427 most?

Nurse Practitioner, with 19,170 services from 93 clinicians. Next are Ophthalmology, Urology, Internal Medicine.

CPT 99427

Principal care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by health care professional, per calendar month

$45.31Medicare-allowed amount per service, averaged across 107,285 services

Providers submitted

$110.36

Asking price, not received

Medicare allowed

$45.31

The fee schedule figure

Medicare paid

$35.81

Balance is patient coinsurance

Providers submitted an average of $110.36 for this code and Medicare allowed $45.31 — 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 $35.81 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $45.50
Hospital / facility: $33.21

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. 105,670 services were billed in an office setting and 1,615 in a facility.

Services: 107,285
Beneficiaries: 46,042
Providers billing it: 898
Total allowed: $4,861,083

What Medicare pays for CPT 99427

Across 107,285 services billed by 898 providers to 46,042 beneficiaries, Medicare allowed an average of $45.31 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 99427

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	19,170	5,949	$38.71	93
Ophthalmology	19,135	10,471	$48.99	195
Urology	14,106	6,721	$46.92	263
Internal Medicine	8,204	4,100	$44.68	21
Cardiology	6,726	2,586	$46.30	64
Emergency Medicine	6,530	1,969	$51.93	4
Physician Assistant	6,041	4,106	$40.81	38
Nephrology	4,731	1,090	$44.93	37
Rheumatology	3,522	1,290	$49.33	22
Neurology	2,724	962	$45.70	20
Physical Medicine and Rehabilitation	2,216	580	$46.04	8
Family Practice	2,136	802	$46.65	12
Pulmonary Disease	2,011	703	$45.05	11
Orthopedic Surgery	1,683	1,315	$45.81	34
Pain Management	1,584	397	$45.54	4

99427 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	12,621	$45.65	$35.93	48
Texas	11,959	$41.30	$33.63	85
New York	11,679	$48.55	$35.28	51
Maryland	6,652	$50.05	$35.94	97
Illinois	6,143	$43.60	$33.92	33
Arizona	5,951	$45.18	$35.79	76
Kentucky	5,597	$43.89	$35.33	10
Tennessee	5,498	$44.43	$36.01	49
Colorado	4,181	$48.68	$36.41	33
Arkansas	3,706	$39.98	$33.98	22
California	2,902	$48.63	$35.53	35
Missouri	2,770	$39.26	$31.85	15
New Jersey	2,433	$51.50	$36.30	42
Nevada	2,318	$46.76	$36.41	18
Washington	2,248	$50.88	$36.80	20
Virginia	2,198	$48.87	$36.46	35
Oklahoma	1,682	$42.91	$34.94	10
Ohio	1,424	$42.81	$35.06	18
Delaware	1,420	$46.23	$35.34	16
District of Columbia	1,373	$44.94	$31.80	3
Pennsylvania	1,271	$42.49	$33.24	10
Utah	1,227	$47.09	$34.49	2
Georgia	1,175	$41.75	$33.61	13
New Mexico	1,039	$44.07	$37.10	3
Michigan	1,032	$37.79	$29.49	15
Louisiana	933	$43.96	$35.22	12
South Carolina	864	$46.55	$36.53	12
Indiana	617	$44.18	$36.09	18
Massachusetts	600	$47.43	$34.42	13
North Carolina	529	$44.61	$36.09	10
Alabama	499	$42.58	$35.28	15
Iowa	488	$42.13	$33.66	10
Idaho	416	$42.26	$33.69	11
Oregon	367	$47.27	$31.36	12
Rhode Island	346	$38.90	$31.35	1
Mississippi	303	$43.96	$35.38	6
Hawaii	220	$49.92	$36.18	5
Nebraska	189	$43.48	$37.00	5
Wyoming	188	$45.80	$36.12	1
North Dakota	68	$48.11	$34.47	2
Maine	43	$36.29	$31.50	1
Connecticut	33	$47.73	$37.06	1
Minnesota	27	$33.63	$26.81	1
Alaska	23	$58.91	$37.05	1
Kansas	19	$37.17	$31.51	1
South Dakota	14	$38.58	$31.43	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.