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Code Reality Check

Code Reality Check.

The 50-state truth for any CPT code.

Paste a code in a pitch deck and someone asks "says who." This answers with the verified spread: state by state, payer-blind local peer percentiles against the Medicare anchor.

314M+ commercial rate records, live in one index 30,000+ codes clear the publication floor, live across the full code universe 50 states · 500+ payers
The lookup

Type a code. Get its country.

This is navigation, not a tool. A launch code opens its published page. Everything else routes to the live app, where the full interactive check runs.

Five-digit CPT. Launch codes open a published 50-state page. The rest deep-link to the live app lookup.

The worked example

99213 pays a different price in every state.

The same established-patient office visit tops out at a median $124.57 in Wisconsin, against a national Medicare anchor of $92.42 flat. The floor sits well below that, and the gap runs the width of the country.

99213 across the 50 states and D.C.

as of Jul 2026
Hydrating the 50-state spread from the live index.
Median (P50) of verified commercial rates per state, payer-blind, on a shared axis. Bar length is each state median relative to the national top. Derived from federally mandated Transparency-in-Coverage MRFs, ingested 2026-07; methodology v1.0.
Medicare anchor
$92.42
CY2026 national non-facility allowed amount for 99213. The shared denominator every state median is measured against.

Documented reimbursement opportunity, modeled not guaranteed. Medians publish only where the verified sample clears the suppression floor.

Cite this

Reddenda, Code Reality Check: 99213, 50-state spread, vintage 2026-07. reddenda.com/code/99213/
The launch directory

The codes that already cleared the floor.

A code publishes when its verified sample clears the suppression floor. Coverage expands weekly. The directory below hydrates from the live index.

Office visits indexing

Directory hydrates from the live index.The published office, preventive, behavioral health, physical therapy, imaging, lab, procedure, and emergency codes load here. If this note persists, the index is between refreshes.
What a code page carries

Every code page is built the same way.

The 50-state spread

Every state median on one axis, each tagged with its confidence tier: Directional at 11 to 24 verified points, Standard at 25 to 99, Benchmark-grade at 100 and up. Below the floor a state shows no number, never a zero.

The rate fingerprint

A share card that reduces the code to its shape: the median, the P25 to P75 band, and the multiple of Medicare. Built to paste into a deck, a memo, or a filing with the citation attached.

The Medicare anchor and payers

The CY2026 non-facility allowed amount, plus the per-payer breakdown where it clears the floor. Per-payer coverage is rebuilding right now, so it renders honest empties until each cell clears.

Track a code

Watch a code, and act when it moves.

The published pages are the record. The app is where you save a code, watch its spread, and run your own NPI against it.

Watch this code on the app

Save any code, get its 50-state spread on your dashboard, and see where your own contracted rate lands against the local peer median.

Put a code in front of a payer

Turn a code's spread into a counteroffer memo or a renewal exhibit. A discovery call is where we scope it against your practice.

Method and provenance

How a number earns a place on the page.

The rules, one definition everywhere

Publication floor. A cell publishes only at n ≥ 11 verified rate points with a non-degenerate spread. Below it: no number, no share card.
Confidence tiers. Directional 11 to 24, median only. Standard 25 to 99, median plus P25 to P75. Benchmark-grade 100 and up, full band.
Whitelist and gate. Payer-blind local peer medians. No national average, ever. A degenerate or filler-flat distribution is suppressed.
Derivation. Federally mandated Transparency-in-Coverage MRFs, verified to real NPIs, measured against CMS PFS CY2026 national non-facility.

As-of and citation

Source: Reddenda Code Reality Check. Vintage 2026-07, methodology v1.0. Denominator: CMS PFS CY2026 national non-facility. https://reddenda.health/code/

Dollar figures are documented reimbursement opportunity, modeled not guaranteed. No PHI required. Reddenda takes no payer money.

For healthcare providers

This page describes your market. The healthcare platform scores your own rates against it: a free RateScore for any NPI, and the tools to move it.

Run your NPI freereddenda.com ↗