How much does Medicare pay for CPT 99443?

Medicare allowed an average of $120.39 per service and paid $88.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $281.24, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99443?

Telephone medical discussion with physician, 21-30 minutes. It was billed 618,679 times to 403,241 Medicare beneficiaries by 12,074 providers in 2024.

Does 99443 pay differently in an office than a hospital?

Yes. The allowed amount averaged $122.35 in an office setting and $94.19 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 99443 most?

Internal Medicine, with 127,089 services from 2,076 clinicians. Next are Nurse Practitioner, Family Practice, Psychiatry.

CPT 99443

Telephone medical discussion with physician, 21-30 minutes

$120.39Medicare-allowed amount per service, averaged across 618,679 services

Providers submitted

$281.24

Asking price, not received

Medicare allowed

$120.39

The fee schedule figure

Medicare paid

$88.50

Balance is patient coinsurance

Providers submitted an average of $281.24 for this code and Medicare allowed $120.39 — 2.3× 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 $88.50 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $122.35
Hospital / facility: $94.19

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. 575,709 services were billed in an office setting and 42,970 in a facility.

Services: 618,679
Beneficiaries: 403,241
Providers billing it: 12,074
Total allowed: $74,482,765

What Medicare pays for CPT 99443

Across 618,679 services billed by 12,074 providers to 403,241 beneficiaries, Medicare allowed an average of $120.39 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 99443

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	127,089	73,563	$125.60	2,076
Nurse Practitioner	124,122	83,562	$105.57	2,581
Family Practice	49,508	31,424	$124.17	963
Psychiatry	34,005	13,125	$123.27	473
Cardiology	29,360	22,691	$127.99	522
Physician Assistant	28,920	22,926	$103.52	809
Hematology-Oncology	21,990	15,459	$125.00	499
Urology	15,852	13,067	$127.64	377
Anesthesiology	15,603	7,745	$131.46	98
Pulmonary Disease	12,744	10,145	$126.01	283
Neurology	12,339	8,921	$127.28	305
Gastroenterology	12,132	9,795	$122.77	281
Nephrology	11,860	8,348	$117.87	267
Physical Medicine and Rehabilitation	11,378	5,171	$131.84	129
Endocrinology	9,783	7,500	$129.22	244

99443 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	174,809	$127.72	$89.74	2,426
Massachusetts	72,544	$120.80	$81.82	1,621
New York	60,078	$128.97	$88.90	1,034
Texas	36,776	$113.26	$87.35	677
Illinois	36,715	$121.03	$86.81	854
Florida	34,969	$115.79	$89.30	575
New Jersey	19,943	$129.20	$90.87	315
Maryland	15,274	$116.88	$87.88	312
Arizona	14,108	$111.57	$87.46	280
Pennsylvania	11,623	$115.39	$86.69	295
Michigan	11,520	$108.76	$86.29	333
Washington	7,943	$118.64	$84.14	235
Virginia	7,858	$117.48	$86.86	186
Ohio	7,666	$104.52	$78.18	268
Connecticut	6,652	$121.28	$88.22	123
Tennessee	6,340	$104.27	$82.93	121
North Carolina	6,136	$108.29	$83.23	210
Minnesota	6,117	$117.86	$86.54	216
Georgia	6,056	$112.11	$88.48	152
Colorado	5,674	$113.17	$85.19	143
Indiana	4,900	$102.69	$76.22	122
Nevada	4,743	$106.05	$83.12	74
New Hampshire	4,615	$115.76	$84.73	161
Wisconsin	4,566	$109.08	$82.83	119
Oregon	4,286	$110.11	$83.47	141
Rhode Island	4,156	$122.75	$89.03	96
Mississippi	3,745	$100.65	$83.61	46
Kentucky	3,456	$99.00	$82.67	54
Alabama	3,379	$103.32	$82.80	98
South Carolina	3,267	$108.51	$85.50	83
Louisiana	3,115	$109.49	$90.77	50
Missouri	3,105	$112.52	$86.24	78
Oklahoma	3,099	$107.26	$88.88	54
New Mexico	3,036	$111.07	$85.21	59
Arkansas	2,020	$99.26	$83.03	58
Kansas	1,879	$107.73	$86.92	48
District of Columbia	1,603	$134.00	$87.80	46
Delaware	1,596	$115.22	$85.70	40
Vermont	1,514	$109.21	$82.93	37
West Virginia	1,163	$111.72	$78.04	29
Montana	1,074	$103.21	$78.58	39
Maine	1,049	$99.56	$79.17	39
Utah	603	$102.48	$89.62	15
Hawaii	570	$121.85	$86.52	22
Nebraska	562	$98.82	$80.58	18
Alaska	508	$140.82	$82.75	17
Wyoming	452	$112.08	$85.09	14
Idaho	429	$99.97	$80.22	16
Iowa	380	$103.04	$85.93	9
Puerto Rico	342	$108.30	$92.82	6
AE	236	$105.14	$77.50	1
Guam	139	$113.52	$88.71	1
XX	122	$107.10	$80.85	1
South Dakota	78	$106.17	$72.97	4
U.S. Virgin Islands	53	$124.91	$73.76	1
North Dakota	38	$96.24	$69.68	2

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
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.