How much does Medicare pay for CPT 99484?

Medicare allowed an average of $50.05 per service and paid $39.33 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $109.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 99484 pay differently in an office than a hospital?

Yes. The allowed amount averaged $50.40 in an office setting and $42.14 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 99484 most?

Nurse Practitioner, with 160,451 services from 577 clinicians. Next are Psychiatry, Internal Medicine, Physician Assistant.

CPT 99484

Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional

$50.05Medicare-allowed amount per service, averaged across 422,066 services

Providers submitted

$109.42

Asking price, not received

Medicare allowed

$50.05

The fee schedule figure

Medicare paid

$39.33

Balance is patient coinsurance

Providers submitted an average of $109.42 for this code and Medicare allowed $50.05 — 2.2× 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 $39.33 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $50.40
Hospital / facility: $42.14

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. 404,090 services were billed in an office setting and 17,976 in a facility.

Services: 422,066
Beneficiaries: 139,839
Providers billing it: 1,218
Total allowed: $21,124,403

What Medicare pays for CPT 99484

Across 422,066 services billed by 1,218 providers to 139,839 beneficiaries, Medicare allowed an average of $50.05 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 99484

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	160,451	49,472	$45.68	577
Psychiatry	59,079	19,578	$53.37	40
Internal Medicine	44,504	12,222	$54.71	133
Physician Assistant	41,689	16,374	$46.22	98
Psychologist, Clinical	27,630	9,845	$51.81	57
Family Practice	25,269	7,986	$53.25	122
Pain Management	12,727	4,850	$54.25	46
Anesthesiology	11,656	3,325	$54.38	35
Emergency Medicine	10,258	5,353	$59.79	9
Cardiology	8,325	3,309	$55.63	7
Physical Medicine and Rehabilitation	4,424	2,123	$55.43	22
Interventional Pain Management	3,428	1,655	$54.28	17
Nephrology	3,067	548	$56.11	6
General Practice	2,427	750	$52.97	8
Certified Clinical Nurse Specialist	2,088	397	$48.60	2

99484 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
Pennsylvania	64,707	$46.37	$36.87	197
New York	61,004	$51.53	$39.08	42
California	54,221	$54.10	$41.06	130
Florida	44,670	$49.75	$39.07	71
Texas	25,672	$51.89	$40.94	72
Nevada	19,401	$52.82	$41.79	16
New Jersey	12,935	$53.83	$39.24	60
Ohio	11,746	$45.60	$37.08	70
Massachusetts	10,162	$48.31	$36.49	12
Georgia	9,928	$49.00	$39.23	21
Maryland	9,892	$50.73	$37.63	34
South Carolina	9,251	$49.33	$40.12	73
Connecticut	7,692	$53.18	$39.95	24
Kentucky	7,579	$44.17	$36.50	69
Virginia	7,191	$45.01	$35.26	19
Arizona	6,618	$51.87	$41.20	19
Oregon	4,885	$56.59	$42.74	4
New Hampshire	4,583	$46.32	$36.31	5
North Carolina	4,128	$47.91	$39.07	63
Washington	4,039	$52.25	$39.88	17
Colorado	3,720	$49.37	$38.83	7
Illinois	3,616	$54.26	$40.34	20
Rhode Island	3,194	$48.24	$36.92	4
Missouri	2,960	$42.62	$34.81	5
West Virginia	2,941	$44.89	$36.72	5
Michigan	2,872	$47.59	$38.10	30
Vermont	2,722	$45.69	$36.25	2
Tennessee	2,451	$44.71	$35.85	20
Utah	2,297	$50.59	$41.04	10
New Mexico	1,957	$44.63	$36.43	4
Alabama	1,573	$50.45	$40.95	6
Oklahoma	1,368	$50.91	$41.08	8
Iowa	1,331	$43.75	$35.89	1
Delaware	1,307	$46.18	$34.96	8
Indiana	1,255	$44.13	$36.38	26
Idaho	1,248	$43.71	$36.74	6
Louisiana	983	$48.23	$38.54	4
District of Columbia	875	$59.41	$42.43	2
Minnesota	597	$49.00	$36.61	3
Wisconsin	565	$43.28	$36.10	11
Maine	565	$45.50	$34.27	2
Arkansas	521	$49.68	$42.65	4
Mississippi	519	$49.24	$37.53	5
Hawaii	273	$56.42	$42.62	4
Wyoming	52	$51.01	$40.56	3

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.