How much does Medicare pay for CPT 99451?

Medicare allowed an average of $34.10 per service and paid $26.22 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $83.58, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99451 pay differently in an office than a hospital?

Yes. The allowed amount averaged $33.95 in an office setting and $34.53 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 99451 most?

Psychiatry, with 34,408 services from 27 clinicians. Next are Cardiology, Neurology, Interventional Cardiology.

CPT 99451

Telephone, internet, or electronic health record assessment and management with written report by consulting physician, at least 5 minutes

$34.10Medicare-allowed amount per service, averaged across 90,254 services

Providers submitted

$83.58

Asking price, not received

Medicare allowed

$34.10

The fee schedule figure

Medicare paid

$26.22

Balance is patient coinsurance

Providers submitted an average of $83.58 for this code and Medicare allowed $34.10 — 2.5× 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 $26.22 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $33.95
Hospital / facility: $34.53

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 65,917 services were billed in an office setting and 24,337 in a facility.

Services: 90,254
Beneficiaries: 57,813
Providers billing it: 1,393
Total allowed: $3,077,661

What Medicare pays for CPT 99451

Across 90,254 services billed by 1,393 providers to 57,813 beneficiaries, Medicare allowed an average of $34.10 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 99451

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychiatry	34,408	7,171	$33.89	27
Cardiology	9,868	9,057	$34.00	256
Neurology	6,132	5,426	$35.73	116
Interventional Cardiology	5,635	4,981	$33.68	99
Dermatology	5,196	5,089	$35.55	91
Endocrinology	4,133	3,433	$36.53	102
Nurse Practitioner	3,422	2,929	$28.35	86
Internal Medicine	2,902	2,716	$34.64	59
Infectious Disease	2,901	2,551	$35.01	93
Hematology-Oncology	2,088	2,054	$34.92	50
Clinical Cardiac Electrophysiology	1,911	1,724	$34.47	42
Physician Assistant	1,909	1,818	$29.11	46
Gastroenterology	1,125	1,117	$34.31	47
Interventional Radiology	1,039	1,006	$34.98	30
Hematology	745	743	$35.26	28

99451 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
Nevada	17,163	$33.75	$26.78	7
California	9,356	$37.20	$25.50	183
Texas	8,911	$33.34	$25.69	155
Colorado	8,500	$34.40	$26.66	18
Washington	7,644	$34.93	$26.52	73
Arizona	5,315	$32.85	$26.03	25
Minnesota	4,490	$33.83	$25.40	186
Virginia	3,875	$33.85	$25.51	88
Indiana	2,686	$31.51	$25.24	73
Oregon	2,232	$34.72	$25.27	48
Pennsylvania	1,971	$33.61	$25.02	69
New York	1,848	$36.58	$24.57	43
Michigan	1,635	$33.90	$24.47	39
Florida	1,349	$33.64	$25.72	42
Utah	1,243	$33.29	$26.32	12
Arkansas	1,158	$31.55	$26.77	29
North Carolina	1,095	$33.12	$25.65	34
Tennessee	1,049	$33.12	$25.69	26
Missouri	986	$32.63	$25.06	22
Massachusetts	918	$35.64	$24.61	19
Ohio	859	$33.46	$24.24	26
Louisiana	702	$33.11	$25.23	22
Wisconsin	681	$33.01	$24.98	23
Vermont	680	$33.24	$24.51	24
Mississippi	592	$27.78	$22.06	6
Illinois	419	$33.08	$25.34	13
Alabama	384	$32.38	$25.48	9
Maryland	377	$35.35	$24.88	9
Georgia	368	$33.96	$24.09	14
New Jersey	289	$36.32	$26.01	11
Oklahoma	284	$34.02	$26.02	2
West Virginia	223	$34.84	$26.54	6
Maine	214	$33.55	$24.06	5
Nebraska	174	$32.43	$26.08	7
Iowa	137	$32.31	$23.00	3
New Mexico	130	$31.15	$23.08	7
Kentucky	64	$28.39	$22.31	2
Montana	51	$34.16	$27.14	3
Idaho	47	$32.35	$26.05	3
Alaska	37	$45.49	$27.06	1
Connecticut	36	$34.44	$22.44	1
Delaware	27	$34.12	$27.15	1
South Carolina	22	$33.47	$25.95	2
New Hampshire	17	$34.43	$23.95	1
District of Columbia	16	$35.55	$25.44	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.