How much does Medicare pay for CPT 99474?

Medicare allowed an average of $15.78 per service and paid $11.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $31.90, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99474?

Self measured blood pressure measurements. It was billed 3,163 times to 1,071 Medicare beneficiaries by 39 providers in 2024.

Which specialty bills 99474 most?

Internal Medicine, with 2,299 services from 13 clinicians. Next are Cardiology, Family Practice, Clinical Cardiac Electrophysiology.

CPT 99474

Self measured blood pressure measurements

$15.78Medicare-allowed amount per service, averaged across 3,163 services

Providers submitted

$31.90

Asking price, not received

Medicare allowed

$15.78

The fee schedule figure

Medicare paid

$11.75

Balance is patient coinsurance

Providers submitted an average of $31.90 for this code and Medicare allowed $15.78 — 2.0× 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 $11.75 (74%); the rest is the patient’s coinsurance and deductible.

Services: 3,163
Beneficiaries: 1,071
Providers billing it: 39
Total allowed: $49,912

What Medicare pays for CPT 99474

Across 3,163 services billed by 39 providers to 1,071 beneficiaries, Medicare allowed an average of $15.78 per service. That is 3.0 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 99474

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	2,299	433	$15.17	13
Cardiology	342	234	$18.80	8
Family Practice	310	247	$15.97	13
Clinical Cardiac Electrophysiology	78	53	$17.61	2
Interventional Cardiology	69	57	$16.64	1
Neurology	51	36	$18.60	1
Nurse Practitioner	14	11	$12.81	1

99474 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
Mississippi	1,720	$14.72	$12.64	2
New York	419	$18.59	$12.63	6
Florida	332	$16.03	$12.27	4
California	227	$18.42	$11.80	8
Texas	84	$16.07	$11.39	2
Michigan	80	$15.86	$10.10	4
Georgia	76	$15.34	$10.27	2
Kansas	58	$15.25	$9.55	2
South Dakota	25	$16.14	$9.41	1
Colorado	23	$16.92	$12.32	1
Kentucky	22	$15.09	$10.35	1
Alabama	21	$14.92	$10.82	1
Arizona	19	$16.09	$9.66	1
Missouri	17	$15.01	$10.30	1
Connecticut	15	$18.31	$13.05	1
Nevada	14	$12.81	$7.06	1
Arkansas	11	$14.80	$13.05	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.