How much does Medicare pay for CPT 99442?

Medicare allowed an average of $83.84 per service and paid $60.68 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $180.37, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99442?

Telephone medical discussion with physician, 11-20 minutes. It was billed 954,193 times to 634,915 Medicare beneficiaries by 17,592 providers in 2024.

Does 99442 pay differently in an office than a hospital?

Yes. The allowed amount averaged $86.30 in an office setting and $59.33 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 99442 most?

Internal Medicine, with 218,214 services from 3,313 clinicians. Next are Nurse Practitioner, Family Practice, Physician Assistant.

CPT 99442

Telephone medical discussion with physician, 11-20 minutes

$83.84Medicare-allowed amount per service, averaged across 954,193 services

Providers submitted

$180.37

Asking price, not received

Medicare allowed

$83.84

The fee schedule figure

Medicare paid

$60.68

Balance is patient coinsurance

Providers submitted an average of $180.37 for this code and Medicare allowed $83.84 — 2.2× 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 $60.68 (72%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $86.30
Hospital / facility: $59.33

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. 867,149 services were billed in an office setting and 87,044 in a facility.

Services: 954,193
Beneficiaries: 634,915
Providers billing it: 17,592
Total allowed: $79,999,541

What Medicare pays for CPT 99442

Across 954,193 services billed by 17,592 providers to 634,915 beneficiaries, Medicare allowed an average of $83.84 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 99442

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	218,214	129,566	$90.41	3,313
Nurse Practitioner	170,842	122,065	$70.58	3,626
Family Practice	110,710	68,747	$87.70	2,069
Physician Assistant	77,773	55,430	$69.69	1,461
Psychiatry	43,773	14,893	$90.70	421
Cardiology	42,370	31,339	$88.62	665
Urology	33,114	27,563	$85.95	767
Hematology-Oncology	22,093	16,666	$83.94	585
Anesthesiology	15,119	7,354	$88.53	139
Gastroenterology	15,032	12,394	$90.83	319
Physical Medicine and Rehabilitation	14,933	8,063	$88.79	228
General Practice	12,249	7,149	$91.09	114
Pulmonary Disease	11,734	9,435	$87.13	304
Pain Management	10,394	5,891	$90.95	120
Nephrology	10,383	7,665	$80.41	243

99442 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	214,235	$89.29	$62.37	3,142
New York	192,426	$85.67	$58.08	2,109
Florida	57,678	$83.55	$62.61	919
Texas	44,877	$79.87	$61.32	983
Massachusetts	41,388	$85.51	$58.18	925
New Jersey	41,208	$88.62	$61.87	683
Illinois	40,575	$84.98	$60.50	983
Michigan	29,064	$80.92	$60.52	572
Pennsylvania	27,657	$81.55	$60.96	577
Maryland	25,410	$83.70	$62.01	448
Arizona	19,204	$78.57	$61.58	421
Virginia	16,571	$82.88	$59.99	379
Ohio	14,922	$73.43	$55.79	473
Georgia	12,568	$77.58	$62.57	282
North Carolina	11,362	$75.58	$58.72	389
Washington	11,052	$82.85	$58.58	366
Indiana	10,096	$74.74	$58.78	201
Alabama	9,793	$74.37	$61.80	197
Tennessee	9,178	$74.37	$59.00	207
Minnesota	9,035	$82.41	$60.53	351
Connecticut	8,756	$85.43	$59.42	226
South Carolina	8,099	$77.66	$59.54	156
Rhode Island	6,812	$87.42	$60.31	162
Wisconsin	6,589	$71.47	$54.82	206
Missouri	6,524	$77.83	$59.65	156
Colorado	6,259	$82.37	$59.72	194
New Mexico	5,355	$75.07	$59.47	140
Oregon	5,271	$79.07	$58.48	208
Kentucky	5,178	$71.61	$58.96	95
Oklahoma	5,172	$69.94	$60.31	89
Kansas	5,077	$78.70	$63.20	80
Arkansas	4,609	$70.18	$57.43	120
District of Columbia	4,503	$70.58	$49.57	48
Delaware	4,285	$79.38	$60.49	90
West Virginia	3,894	$75.87	$58.77	106
New Hampshire	3,759	$81.59	$60.23	140
Hawaii	3,471	$80.63	$54.03	70
Nevada	3,270	$77.48	$61.95	95
Maine	2,301	$73.36	$56.02	67
Louisiana	2,253	$75.80	$58.56	66
Mississippi	2,017	$73.30	$56.29	73
Montana	2,015	$67.96	$49.30	71
Vermont	1,812	$81.17	$61.72	44
Alaska	1,636	$95.13	$55.42	69
Idaho	1,491	$67.75	$56.95	48
Nebraska	1,370	$68.18	$55.02	48
Puerto Rico	1,019	$74.29	$63.71	23
Wyoming	750	$79.29	$61.35	25
Utah	747	$78.42	$62.28	21
Iowa	652	$79.35	$59.96	21
South Dakota	351	$66.07	$47.60	11
North Dakota	206	$69.43	$53.06	7
Guam	177	$76.99	$61.78	1
U.S. Virgin Islands	133	$78.74	$60.13	6
ZZ	52	$66.95	$40.87	2
AE	29	$74.23	$60.17	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
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
99484Care management services for behavioral health conditions$50.05

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.