How much does Medicare pay for CPT 99452?

Medicare allowed an average of $28.58 per service and paid $22.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $74.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99452?

Telephone or internet referral service, 30 minutes. It was billed 38,279 times to 10,797 Medicare beneficiaries by 167 providers in 2024.

Does 99452 pay differently in an office than a hospital?

Yes. The allowed amount averaged $28.52 in an office setting and $32.74 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 99452 most?

Nurse Practitioner, with 33,602 services from 102 clinicians. Next are Physician Assistant, Family Practice, Internal Medicine.

CPT 99452

Telephone or internet referral service, 30 minutes

$28.58Medicare-allowed amount per service, averaged across 38,279 services

Providers submitted

$74.72

Asking price, not received

Medicare allowed

$28.58

The fee schedule figure

Medicare paid

$22.58

Balance is patient coinsurance

Providers submitted an average of $74.72 for this code and Medicare allowed $28.58 — 2.6× 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 $22.58 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $28.52
Hospital / facility: $32.74

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 37,734 services were billed in an office setting and 545 in a facility.

Services: 38,279
Beneficiaries: 10,797
Providers billing it: 167
Total allowed: $1,094,014

What Medicare pays for CPT 99452

Across 38,279 services billed by 167 providers to 10,797 beneficiaries, Medicare allowed an average of $28.58 per service. That is 3.5 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 99452

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	33,602	7,939	$28.07	102
Physician Assistant	901	293	$28.42	6
Family Practice	820	637	$33.53	6
Internal Medicine	813	430	$33.16	10
Nephrology	334	105	$37.48	4
Certified Clinical Nurse Specialist	232	45	$27.48	1
Cardiology	220	199	$31.25	7
Neurology	216	142	$35.31	3
Physical Medicine and Rehabilitation	185	146	$33.30	3
General Practice	169	145	$32.36	3
Interventional Cardiology	169	162	$31.21	4
Obstetrics & Gynecology	109	58	$34.66	1
Hematology-Oncology	81	81	$32.06	2
Psychiatry	80	80	$33.16	4
Vascular Surgery	80	80	$33.16	1

99452 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	13,866	$27.87	$22.22	22
Colorado	8,428	$28.41	$22.32	18
Utah	2,465	$27.49	$22.34	9
Arizona	2,436	$27.89	$22.14	20
Texas	2,140	$29.19	$22.69	12
Washington	1,816	$29.25	$22.33	11
Ohio	1,418	$28.16	$22.45	4
Florida	921	$28.30	$22.50	2
New York	618	$34.80	$23.87	6
California	571	$34.43	$25.17	6
Idaho	469	$26.83	$22.41	4
Virginia	465	$33.46	$26.21	1
Tennessee	458	$28.69	$22.65	2
Arkansas	381	$31.18	$26.04	11
Illinois	287	$34.81	$25.73	4
Maryland	282	$32.04	$22.84	7
New Mexico	271	$27.67	$22.41	2
Connecticut	216	$28.28	$22.35	1
Pennsylvania	147	$31.97	$24.52	2
Kentucky	106	$30.15	$22.66	2
Mississippi	75	$29.58	$19.05	2
Wyoming	70	$28.64	$22.40	1
Oregon	65	$29.39	$22.69	3
South Carolina	62	$33.59	$25.53	1
North Carolina	44	$32.55	$25.89	2
Michigan	42	$28.42	$22.30	3
Georgia	38	$32.33	$24.25	2
Iowa	36	$31.59	$23.58	1
Nebraska	25	$29.03	$22.33	2
Missouri	22	$32.58	$23.90	1
Oklahoma	15	$29.75	$26.79	1
Massachusetts	12	$33.74	$26.35	1
New Jersey	12	$36.11	$26.36	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.