How much does Medicare pay for CPT 99454?

Medicare allowed an average of $47.97 per service and paid $36.94 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $129.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99454 pay differently in an office than a hospital?

Yes. The allowed amount averaged $47.97 in an office setting and $48.26 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 99454 most?

Internal Medicine, with 496,514 services from 1,748 clinicians. Next are Cardiology, Family Practice, Nephrology.

CPT 99454

Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days

$47.97Medicare-allowed amount per service, averaged across 2,027,677 services

Providers submitted

$129.67

Asking price, not received

Medicare allowed

$47.97

The fee schedule figure

Medicare paid

$36.94

Balance is patient coinsurance

Providers submitted an average of $129.67 for this code and Medicare allowed $47.97 — 2.7× 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 $36.94 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $47.97
Hospital / facility: $48.26

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 2,012,530 services were billed in an office setting and 15,147 in a facility.

Services: 2,027,677
Beneficiaries: 388,896
Providers billing it: 6,419
Total allowed: $97,267,666

What Medicare pays for CPT 99454

Across 2,027,677 services billed by 6,419 providers to 388,896 beneficiaries, Medicare allowed an average of $47.97 per service. That is 5.2 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 99454

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	496,514	93,518	$49.43	1,748
Cardiology	467,801	79,598	$49.19	841
Family Practice	335,329	63,872	$47.44	1,356
Nephrology	149,257	25,355	$46.19	509
Nurse Practitioner	123,797	29,346	$40.14	725
Interventional Cardiology	93,856	15,309	$47.92	215
Geriatric Medicine	55,308	19,111	$48.89	19
Pulmonary Disease	46,799	8,265	$47.27	157
Emergency Medicine	37,753	9,689	$49.35	48
Sleep Medicine	32,600	5,268	$50.80	28
Endocrinology	30,402	5,630	$49.79	96
Clinical Cardiac Electrophysiology	23,477	3,634	$49.71	67
Physician Assistant	21,306	4,958	$41.32	144
General Practice	20,667	3,782	$51.77	63
Gastroenterology	10,865	2,023	$44.40	90

99454 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	422,814	$54.89	$35.71	858
Texas	184,798	$44.97	$35.38	674
Florida	177,386	$45.29	$35.63	470
New York	155,787	$51.66	$35.16	515
Virginia	95,016	$46.81	$34.66	220
Arizona	91,467	$45.10	$35.07	297
Georgia	85,291	$42.46	$35.15	310
New Jersey	83,229	$52.87	$35.83	314
Maryland	70,988	$53.88	$34.25	227
Connecticut	67,649	$49.45	$36.64	39
Illinois	58,835	$47.11	$35.76	230
Tennessee	54,261	$41.26	$34.83	155
Missouri	35,224	$44.14	$35.63	58
South Carolina	35,076	$42.46	$34.77	165
Michigan	33,356	$46.23	$35.76	147
Alabama	30,399	$40.14	$35.29	149
Iowa	29,159	$41.11	$33.13	176
North Carolina	24,313	$42.78	$35.03	134
Nevada	23,114	$46.38	$35.67	88
Louisiana	22,304	$40.06	$35.23	81
Pennsylvania	21,751	$45.99	$35.45	117
Oklahoma	17,770	$41.40	$35.27	76
Washington	16,319	$47.36	$34.37	71
Ohio	16,202	$42.05	$35.01	66
Mississippi	15,893	$39.69	$34.45	75
Massachusetts	15,885	$49.24	$34.81	66
Indiana	14,817	$42.05	$34.85	75
Arkansas	14,675	$39.21	$34.97	84
Kansas	13,392	$42.45	$35.69	40
Utah	11,981	$42.39	$34.18	50
Oregon	11,112	$47.05	$35.55	23
Colorado	10,488	$48.57	$35.59	57
New Mexico	9,106	$41.59	$34.49	39
Delaware	8,775	$45.77	$35.19	21
Kentucky	8,758	$40.75	$35.22	34
Nebraska	8,611	$42.55	$35.01	36
Hawaii	4,694	$51.31	$34.72	22
District of Columbia	4,274	$54.14	$34.88	22
Idaho	4,179	$41.25	$34.16	14
Minnesota	3,619	$45.08	$34.26	30
New Hampshire	3,555	$42.67	$31.57	18
Wisconsin	2,842	$43.41	$33.94	24
Alaska	2,199	$49.70	$35.08	17
South Dakota	1,719	$43.31	$35.18	7
West Virginia	1,418	$41.70	$35.34	10
U.S. Virgin Islands	772	$45.93	$35.14	3
Maine	768	$44.88	$35.96	5
Montana	694	$46.53	$35.61	3
Wyoming	649	$46.07	$36.30	3
North Dakota	261	$41.29	$31.77	3
Rhode Island	33	$21.73	$13.32	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
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
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.