Code Reality Check
99212 reimbursement rate: Office visit, established patient, 10-19 min
Office visit, established patient, 10-19 min (CPT 99212) pays a median $79.51 in Wisconsin and $36.20 in Kentucky, against a Medicare anchor of $56.85. 51 of 51 states clear the publication floor.
spread 2.2x top to bottom
Medicare anchor $56.85
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $79.51 | 1.40x | $45–$115 · P90 $145 | 42,777 | Benchmark |
| New Hampshire | $69.26 | 1.22x | $59–$76 · P90 $187 | 8,254 | Benchmark |
| Colorado | $69.04 | 1.21x | $45–$128 · P90 $150 | 8,885 | Benchmark |
| Maine | $59.75 | 1.05x | $38–$69 · P90 $93 | 10,207 | Benchmark |
| Washington | $59.58 | 1.05x | $33–$92 · P90 $125 | 10,345 | Benchmark |
| Massachusetts | $55.57 | 0.98x | $41–$73 · P90 $116 | 7,104 | Benchmark |
| Minnesota | $55.48 | 0.98x | $42–$81 · P90 $115 | 7,502 | Benchmark |
| Virginia | $55.45 | 0.98x | $47–$66 · P90 $87 | 27,345 | Benchmark |
| Wyoming | $54.61 | 0.96x | $41–$62 · P90 $87 | 604 | Benchmark |
| Pennsylvania | $54.29 | 0.95x | $46–$58 · P90 $79 | 24,332 | Benchmark |
| Delaware | $54.28 | 0.95x | $41–$65 · P90 $98 | 824 | Benchmark |
| Georgia | $53.98 | 0.95x | $41–$72 · P90 $111 | 80,773 | Benchmark |
| Iowa | $52.35 | 0.92x | $42–$73 · P90 $105 | 1,351 | Benchmark |
| Nebraska | $52.35 | 0.92x | $40–$70 · P90 $99 | 527 | Benchmark |
| South Carolina | $52.35 | 0.92x | $41–$54 · P90 $79 | 6,427 | Benchmark |
| South Dakota | $51.07 | 0.90x | $36–$69 · P90 $117 | 212 | Benchmark |
| Mississippi | $51.04 | 0.90x | $37–$66 · P90 $111 | 673 | Benchmark |
| Utah | $50.77 | 0.89x | $38–$76 · P90 $125 | 971 | Benchmark |
| Idaho | $50.62 | 0.89x | $37–$72 · P90 $114 | 709 | Benchmark |
| Illinois | $50.30 | 0.88x | $36–$62 · P90 $101 | 12,878 | Benchmark |
| Montana | $50.27 | 0.88x | $36–$74 · P90 $122 | 490 | Benchmark |
| Maryland | $50.22 | 0.88x | $41–$65 · P90 $96 | 4,772 | Benchmark |
| Louisiana | $50.12 | 0.88x | $38–$69 · P90 $116 | 1,351 | Benchmark |
| North Dakota | $50.07 | 0.88x | $37–$72 · P90 $99 | 303 | Benchmark |
| Oregon | $49.97 | 0.88x | $34–$75 · P90 $131 | 1,977 | Benchmark |
| Hawaii | $49.93 | 0.88x | $38–$70 · P90 $117 | 842 | Benchmark |
| New Mexico | $49.70 | 0.87x | $37–$69 · P90 $116 | 996 | Benchmark |
| North Carolina | $48.85 | 0.86x | $41–$52 · P90 $79 | 98,124 | Benchmark |
| Oklahoma | $48.49 | 0.85x | $36–$66 · P90 $92 | 1,140 | Benchmark |
| Arkansas | $47.75 | 0.84x | $35–$58 · P90 $83 | 1,055 | Benchmark |
| Alaska | $47.39 | 0.83x | $38–$72 · P90 $110 | 368 | Benchmark |
| California | $47.38 | 0.83x | $29–$83 · P90 $180 | 158,479 | Benchmark |
| Tennessee | $46.97 | 0.83x | $36–$58 · P90 $81 | 6,319 | Benchmark |
| District of Columbia | $46.66 | 0.82x | $45–$68 · P90 $101 | 1,798 | Benchmark |
| Kansas | $46.46 | 0.82x | $32–$54 · P90 $77 | 1,634 | Benchmark |
| Arizona | $46.12 | 0.81x | $34–$68 · P90 $116 | 3,536 | Benchmark |
| New Jersey | $45.78 | 0.81x | $40–$73 · P90 $106 | 19,366 | Benchmark |
| Florida | $45.75 | 0.80x | $37–$62 · P90 $99 | 15,928 | Benchmark |
| Alabama | $45.48 | 0.80x | $33–$57 · P90 $96 | 2,312 | Benchmark |
| Texas | $45.45 | 0.80x | $34–$66 · P90 $86 | 29,397 | Benchmark |
| Nevada | $45.15 | 0.79x | $29–$67 · P90 $116 | 1,602 | Benchmark |
| Connecticut | $44.81 | 0.79x | $38–$82 · P90 $116 | 4,499 | Benchmark |
| Michigan | $44.74 | 0.79x | $39–$68 · P90 $108 | 5,644 | Benchmark |
| Indiana | $44.72 | 0.79x | $44–$57 · P90 $69 | 54,505 | Benchmark |
| Missouri | $44.61 | 0.78x | $32–$53 · P90 $77 | 53,449 | Benchmark |
| Vermont | $43.80 | 0.77x | P75 $69 · P90 $87 | 1,290 | Benchmark |
| New York | $43.70 | 0.77x | $35–$74 · P90 $116 | 243,570 | Benchmark |
| Rhode Island | $41.35 | 0.73x | $38–$58 · P90 $71 | 4,821 | Benchmark |
| West Virginia | $40.89 | 0.72x | $34–$57 · P90 $75 | 1,902 | Benchmark |
| Ohio | $39.76 | 0.70x | $34–$56 · P90 $81 | 75,614 | Benchmark |
| Kentucky | $36.20 | 0.64x | $25–$48 · P90 $66 | 21,552 | 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 99212. Reddenda. https://reddenda.health/code/99212/
Derivation federally mandated TiC MRFs, verified to provider identity1,071,335 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0