CMS October 2026Physician Fee Schedule · Free lookup

CPT 99213 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 99213 is $95.19 in a non-facility setting ($57.45 in a facility), up 7.0% from $88.95 in 2025.

National rate, October 2026

Non-facility: $95.19
Facility: $57.45
vs. 2025: +7.0%
Commercial national avg.: $90.26

Filters

HCPCS Codes

99213

State

Year

20262025

Select one or more years

Up to 5 codes · 4 remaining

Need commercial rates?

Compare Medicare against in-network rates from 180+ payers.

Run a free sample report

Showing

Physician Fee Schedule·99213·National·2026, 2025

Current non-facility rate

$95.19▲0.0%

Facility: $57.45

Recent trend

Code description

Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded

Code	Date	State	Non-Facility Fee	Facility Fee	Description
99213	10/2026	N/A	$95.19	$57.45	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	7/2026	N/A	$95.19	$57.45	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	4/2026	N/A	$95.19	$57.45	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	1/2026	N/A	$95.19	$57.45	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	10/2025	N/A	$88.95	$63.72	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	7/2025	N/A	$88.95	$63.72	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	4/2025	N/A	$88.95	$63.72	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded
99213	1/2025	N/A	$88.95	$63.72	Office O P Est Low 20 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded

99213 national rate by year

Each row is the latest CMS file published that year. Change is against the year before.

CMS file	Non-facility	Facility	Change
October 2026	$95.19	$57.45	+7.0%
October 2025	$88.95	$63.72	-2.1%
March 2024	$90.88	$65.24	+0.1%
January 2023	$90.82	$66.08	-1.3%
July 2022	$92.05	$67.48	-

This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.

99213: Medicare vs. commercial national average

The commercial national average for 99213, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $90.26, 95% of Medicare's $95.19.

BCBS $91.46
UnitedHealthcare $86.29
Aetna $82.03
Cigna $101.25

A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99213 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.

See commercial rates in your market Commercial rates for 99213

Nearby codes

99205 Medicare rate 99211 Medicare rate 99212 Medicare rate 99214 Medicare rate 99215 Medicare rate 99221 Medicare rate

PayerPrice Platform

Compare Medicare's rate for 99213 with published commercial rates

Search negotiated rates from more than 180 commercial payers by NPI, TIN, and ZIP code. Review historical rates or export the data through API, SQL, MCP, or bulk download.

Schedule a demo Run a free sample report

Medicaid comparison

State Medicaid programs pay a median of $71.05 for 99213

Across 45 state fee schedules the rate runs from $34.40 in KS to $165.33 in AK - a 4.8x spread. That median is 75% of Medicare's $95.193 national non-facility rate. Free to explore state by state.

17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99213

$24.38

99212Office O P Est Sf 10 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 10 Minutes Must Be Met Or Exceeded

$59.45

99202Office O P New Sf 15 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded

$75.15

Methodology

Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.

View CMS Physician Fee Schedule