CPT 99213 Fee Schedule

Last Verified: November 2025

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

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. (Desc Rvsd 1/1/2024)

Key Fact	Detail
Service Type	• Evaluation and Management • Office or Other Outpatient Services
Common Place of Service	• 11 - Office • 20 - Urgent Care Facility
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video
Complexity Level	Moderate

National average reimbursement for CPT 99213 by major payers:

$91.46

$86.29

$82.03

$121.11

Preview provider-level rates for...

For billing codeCPT 99213

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99213
United	99213	$161.55	1598923294 - HAYLEY TEICH	237425849 - (MA) EAST BOSTON NEIGHBORHOOD HEALTH CENTER CORP	MA	Pediatrics Physician (208000000X)
United	99213	$136.38	1831583368 - ARIANA WITKIN	42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC	MA	Pediatrics Physician (208000000X)
United	99213	$71.41	1376795377 - MELISSA RUIZ	956000944	CA	Pediatrics Physician (208000000X)
United	99213	$165.16	1639332380 - HEMA MAGGE	911336707 - THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS	MA	Pediatrics Physician (208000000X)
United	99213	$125.84	1942399589 - MELISSA ROSIN	271504911 - (CA) MEMORIALCARE MEDICAL FOUNDATION	CA	Pediatrics Physician (208000000X)
United	99213	$56.97	1326049263 - JOSEPH LONGNECKER	330180540 - (CA) CHEST AND CRITICAL CARE CONSULTANTS, A.M.G., INC.	CA	Pediatrics Physician (208000000X)
United	99213	$182.94	1578981551 - MELISSA PARKS	650913389	AZ	Obstetrics & Gynecology Physician (207V00000X)
United	99213	$67.45	1497918825 - ANDREA CARTER	320158728 - SOUTHERN WOMENS HEALTH, PLLC	MS	Obstetrics & Gynecology Physician (207V00000X)
United	99213	$150.60	1013265776 - ABBAS ZAIDI	590634433 - THE NEMOURS FOUNDATION	DE	Pediatrics Physician (208000000X)
United	99213	$71.73	1801895248 - TIMOTHY JOHNSON	454176686 - (NY) URBAN MEDICAL GROUP PLLC	NY	Gastroenterology Physician (207RG0100X)
United	99213	$213.77	1184915803 - JACK NAGGAR	43466314 - (MA) MASS GENERAL BRIGHAM INCORPORATED	MA	Internal Medicine Physician (207R00000X)
United	99213	$96.05	1225319270 - PATARA ROJANAVONGSE	946000531 - (CA) LIBERTY RURAL COUNTY FIRE PROTECTIO N DISTRICT	CA	Pediatrics Physician (208000000X)
United	99213	$97.45	1821364159 - JAMES DALY	43111240 - (MA) EMERSON PRACTICE ASSOCIATES INC	MA	Pediatrics Physician (208000000X)
United	99213	$221.88	1275592917 - GIUSEPPINA ROMANO-CLARKE	42697983 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99213	$89.84	1720083892 - MATTHEW MASIELLO	251856569 - (PA) DUBOIS REGIONAL MEDICAL GROUP, P.C.	MA	Pediatrics Physician (208000000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 99213 vs. Other Office or Other Outpatient Services Codes

The CPT 99213 code is part of the Evaluation and Management services used for Office or Other Outpatient Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99213 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99202	Low	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99203	Low	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99204	Moderate	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99213	Low	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. (Desc Rvsd 1/1/2024)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99213. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99213 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99213) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo

Medicare Reimbursement Lookup Tool

PayerPrice provides a free medicare lookup tool for physician fee schedule, drug ASP, MS-DRG weights, anesthesia conversion factors and other medicare related data.

Search Medicare Rates