Geriatric Medicine reimbursement rates by service line
Compare payer-published geriatric medicine benchmarks for office visits; nursing facility care; hospital care; laboratory context.
Compare national geriatric medicine rates by payer
Use the reference codes to compare payer benchmarks, then explore office visits; nursing facility care; hospital care; laboratory context. Each rate represents a specific billing code and comparison cohort, rather than a complete episode of care.
Aetna state variation for 99214
National 99214 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 99214 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 6,107 | $104.25 | $120.97 | |||
| Cigna | Jun–Jul 2026 | 5,816 | $146.10 | $186.52 | |||
| United | Jun–Jul 2026 | 5,946 | $150.38 | $174.88 | |||
| Anthem | Jun–Jul 2026 | 5,616 | $137.63 | $184.92 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for established patient office visit, level 4 (99214).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
How do specific geriatric medicine providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Geriatric Medicine provider benchmarks (CPT 99214)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| INHOSPITAL PHYSICIANS CORP OF NEW JERSEY PCNPI 1013043520 · Tax ID 824445637 | NJ | 94 | $54.54 | -$49.71 | Below P25 |
| UNIVERSITY MEDICAL SERVICES FOUNDATION INCNPI 1740231687 · Tax ID 611228665 | KY | 78 | $83.28 | -$20.97 | Below P25 |
| MEDICAL FOUNDATION INC NON PROFIT ORGANIZATIONNPI 1669454690 · Tax ID 640834532 | MS | 624 | $94.87 | -$9.38 | P25 to median |
| SOUTH NASSAU MEDICAL GROUP PCNPI 1851470363 · Tax ID 454799159 | NY | 43 | $100.65 | -$3.60 | P25 to median |
| NEW ENGLAND HOSPITALISTS PCNPI 1972823870 · Tax ID 263097313 | MA | 59 | Median to P75 | ||
| LAWRENCE MEDICAL ASSOCIATES PCNPI 1417202615 · Tax ID 264076297 | NY | 671 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates across all three preview codes.
No trial or data preparation required.Explore geriatric medicine services
Compare codes within the same billing context. A reported billing unit may describe a timed service, supply quantity, daily service or procedure; it does not always mean one visit.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per reported billing unit · 11 codes | ||||
99214Established patient office visit, level 4 | $120.97 | $186.52 | $174.88 | $184.92 |
99213Established patient office visit, level 3 | $82.76 | $128.65 | $120.93 | $130.18 |
99232Subsequent hospital inpatient or observation care, level 2 | $87.37 | $124.31 | $112.35 | $129.35 |
99233Subsequent hospital inpatient or observation care, level 3 | $119.51 | $182.52 | $163.21 | $187.46 |
99204New patient office visit, level 4 | $176.76 | $256.62 | $258.07 | $275.33 |
99215Established patient office visit, level 5 | $168.72 | $262.36 | $237.48 | $257.54 |
99203New patient office visit, level 3 | $113.64 | $166.22 | $170.33 | $180.06 |
99223Initial hospital inpatient or observation care, level 3 | $210.07 | $306.10 | $299.12 | $339.51 |
99212Established patient office visit, level 2 | $49.35 | $76.49 | $74.28 | $78.57 |
99222Initial hospital inpatient or observation care, level 2 | $151.09 | $218.94 | $207.56 | $237.60 |
99239Hospital discharge management, more than 30 minutes | $121.23 | $183.05 | $166.14 | $192.84 |
$ per reported billing unit · 6 codes | ||||
85025Complete blood count with differential | $9.85 | $28.47 | $7 | $12.88 |
80053Comprehensive metabolic panel | $13.17 | $38.08 | $9.44 | $17.05 |
83036Hemoglobin A1c | $11.97 | $34.95 | $8.75 | $16.31 |
80061Cholesterol Testing | $15.81 | $49.79 | $12 | $21.86 |
84443Thyroid-stimulating hormone assay | $21.44 | $57.97 | $15.13 | $27.15 |
81003Automated urinalysis without microscopy | $2.61 | $8.08 | $2.41 | $3.72 |
$ per reported billing unit · 3 codes | ||||
99396Preventive visit, established patient age 40–64 | $133.80 | $188.58 | $196.91 | $214.01 |
99395Preventive visit, established patient age 18–39 | $123.55 | $175.62 | $184.74 | $199.58 |
99309Subsequent nursing facility care, level 3 | $106.04 | $169.14 | $142.95 | $169.31 |
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Book a 20-min scoping call No trial or data preparation required.How to interpret these benchmarks
Payer-published rates provide market context. They do not establish a practice's contracted rate or the total cost of care.
- Source and periodRates come from the specialty's national report. The displayed period follows the processed data included in the latest published snapshot and updates when that snapshot is refreshed.
- Comparable ratesComparisons use positive professional fee-for-service negotiated and fee-schedule dollar amounts. Percentages, bundled arrangements and per-diem rate types are excluded. Modifier cohorts and code-specific amounts remain separate.
- CalculationRates are reduced to one modal value per NPI and TIN entity, averaging tied modes. Two percent per tail is targeted for trimming while keeping boundary ties. Benchmarks require at least 10 included entities and are not weighted by patient volume.
- CoverageNational report coverage does not guarantee every payer or state is available for every code. Anthem represents the displayed Anthem cohort, rather than all regional Blue plans. Missing benchmarks are not zero rates.
- Billing contextMatch the exact code, billing unit, modifier, setting and network. Equipment rentals and supplies require their own interval and quantity checks. Professional rates exclude facility charges; anesthesia conversion factors are outside these comparisons.
Get the geriatric medicine reimbursement data you're looking for
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We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
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Explore geriatric medicine rates by state
Choose a state to compare payer reference averages for common services.
Questions about geriatric medicine benchmarks
How to interpret the selected market and payer-published rates.
What does the national benchmark compare?
The headline uses Established patient office visit, level 4 (99214). The other reference codes and service lines provide separate comparisons rather than combining unlike services.
Why is a payer or state missing?
A benchmark appears only when the selected code and cohort meet the publication rules, including at least 10 entities after trimming. Report-wide coverage can be broader than an individual comparison.
Will the reporting period change?
Yes. The period displayed with the benchmark follows the processed source data when the publication snapshot is refreshed.