Code Reality Check
99211 reimbursement rate: Office visit, established patient, minimal
Office visit, established patient, minimal (CPT 99211) pays a median $48.67 in Massachusetts and $14.54 in Delaware, against a Medicare anchor of $23.00. 51 of 51 states clear the publication floor.
spread 3.3x top to bottom
Medicare anchor $23.00
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Massachusetts | $48.67 | 2.12x | $27–$54 · P90 $64 | 34,665 | Benchmark |
| North Dakota | $47.43 | 2.06x | $23–$61 · P90 $66 | 1,395 | Benchmark |
| Connecticut | $42.09 | 1.83x | $21–$70 · P90 $71 | 12,371 | Benchmark |
| South Dakota | $42.02 | 1.83x | $20–$66 · P90 $89 | 664 | Benchmark |
| Oregon | $33.14 | 1.44x | $31–$53 · P90 $53 | 7,647 | Benchmark |
| Hawaii | $31.20 | 1.36x | $28–$50 · P90 $84 | 2,889 | Benchmark |
| Utah | $31.20 | 1.36x | $20–$56 · P90 $56 | 7,241 | Benchmark |
| North Carolina | $30.96 | 1.35x | $29–$31 · P90 $39 | 106,152 | Benchmark |
| Colorado | $30.94 | 1.35x | $19–$55 · P90 $62 | 13,639 | Benchmark |
| Iowa | $30.06 | 1.31x | $19–$39 · P90 $72 | 3,220 | Benchmark |
| Idaho | $28.99 | 1.26x | $19–$45 · P90 $60 | 1,227 | Benchmark |
| Tennessee | $28.95 | 1.26x | $20–$48 · P90 $56 | 11,449 | Benchmark |
| Maryland | $28.76 | 1.25x | $19–$45 · P90 $62 | 10,070 | Benchmark |
| Alaska | $28.04 | 1.22x | $20–$48 · P90 $57 | 630 | Benchmark |
| Arkansas | $27.75 | 1.21x | $22–$42 · P90 $42 | 6,663 | Benchmark |
| District of Columbia | $25.40 | 1.10x | $11–$30 · P90 $48 | 2,907 | Benchmark |
| Michigan | $25.26 | 1.10x | $16–$83 · P90 $100 | 11,685 | Benchmark |
| Wisconsin | $25.19 | 1.10x | $22–$51 · P90 $70 | 49,762 | Benchmark |
| New Mexico | $24.01 | 1.04x | $16–$42 · P90 $60 | 1,524 | Benchmark |
| Oklahoma | $23.93 | 1.04x | $20–$36 · P90 $41 | 3,116 | Benchmark |
| Maine | $23.83 | 1.04x | $12–$32 · P90 $45 | 12,180 | Benchmark |
| Montana | $23.49 | 1.02x | $14–$33 · P90 $55 | 684 | Benchmark |
| New Hampshire | $23.42 | 1.02x | $12–$32 · P90 $38 | 8,494 | Benchmark |
| Washington | $23.36 | 1.02x | $18–$46 · P90 $56 | 14,381 | Benchmark |
| South Carolina | $23.25 | 1.01x | $19–$31 · P90 $48 | 11,660 | Benchmark |
| Pennsylvania | $22.95 | 1.00x | $14–$35 · P90 $52 | 18,660 | Benchmark |
| Louisiana | $22.72 | 0.99x | $21–$48 · P90 $48 | 6,580 | Benchmark |
| Texas | $22.69 | 0.99x | $12–$33 · P90 $53 | 43,010 | Benchmark |
| Illinois | $22.68 | 0.99x | $13–$34 · P90 $53 | 24,130 | Benchmark |
| California | $22.40 | 0.97x | $11–$48 · P90 $89 | 159,915 | Benchmark |
| Arizona | $22.39 | 0.97x | $15–$38 · P90 $53 | 5,376 | Benchmark |
| Virginia | $22.35 | 0.97x | $11–$29 · P90 $36 | 38,115 | Benchmark |
| Florida | $22.17 | 0.96x | $16–$32 · P90 $50 | 26,625 | Benchmark |
| Georgia | $22.05 | 0.96x | $10–$32 · P90 $50 | 90,753 | Benchmark |
| Alabama | $21.88 | 0.95x | $12–$29 · P90 $46 | 3,064 | Benchmark |
| Rhode Island | $21.79 | 0.95x | $9–$29 · P90 $43 | 5,338 | Benchmark |
| Mississippi | $21.34 | 0.93x | $20–$29 · P90 $46 | 1,263 | Benchmark |
| Indiana | $21.15 | 0.92x | $19–$26 · P90 $31 | 54,233 | Benchmark |
| Nevada | $21.00 | 0.91x | $13–$33 · P90 $56 | 2,393 | Benchmark |
| New York | $20.93 | 0.91x | $17–$37 · P90 $55 | 294,001 | Benchmark |
| Nebraska | $20.36 | 0.89x | $20–$40 · P90 $54 | 2,191 | Benchmark |
| Kansas | $20.00 | 0.87x | $11–$27 · P90 $40 | 2,915 | Benchmark |
| Missouri | $19.82 | 0.86x | $10–$23 · P90 $37 | 55,075 | Benchmark |
| Vermont | $19.82 | 0.86x | $10–$32 · P90 $48 | 1,621 | Benchmark |
| New Jersey | $19.37 | 0.84x | $16–$33 · P90 $45 | 27,876 | Benchmark |
| Minnesota | $18.76 | 0.82x | $19–$28 · P90 $38 | 18,880 | Benchmark |
| West Virginia | $18.53 | 0.81x | $10–$25 · P90 $33 | 2,611 | Benchmark |
| Wyoming | $16.83 | 0.73x | $12–$31 · P90 $51 | 729 | Benchmark |
| Ohio | $15.77 | 0.69x | $10–$22 · P90 $34 | 105,169 | Benchmark |
| Kentucky | $15.69 | 0.68x | $10–$22 · P90 $33 | 28,036 | Benchmark |
| Delaware | $14.54 | 0.63x | $7–$30 · P90 $40 | 1,646 | Benchmark |
Payer-blind local peer percentiles per state, full verified distribution. Publication floor: 11 verified rate points and a non-degenerate spread; the P25–P75 band unlocks at 25 points, P90 at 100 (a smaller cell's P90 is one contract, not a statistic).
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
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Cite this page
Source: Reddenda Code Reality Check, CPT 99211. Reddenda. https://reddenda.health/code/99211/
Derivation federally mandated TiC MRFs, verified to provider identity1,356,520 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0