Code Reality Check
99213 reimbursement rate: Office visit, established patient, 20-29 min
Office visit, established patient, 20-29 min (CPT 99213) pays a median $124.57 in Wisconsin and $57.62 in North Carolina, against a Medicare anchor of $92.42. 51 of 51 states clear the publication floor.
spread 2.2x top to bottom
Medicare anchor $92.42
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $124.57 | 1.35x | $86–$194 · P90 $233 | 45,896 | Benchmark |
| New Hampshire | $117.23 | 1.27x | $96–$117 · P90 $165 | 10,113 | Benchmark |
| Vermont | $116.96 | 1.27x | $60–$117 · P90 $147 | 1,237 | Benchmark |
| Colorado | $104.78 | 1.13x | $80–$173 · P90 $236 | 9,605 | Benchmark |
| Maine | $95.73 | 1.04x | $71–$125 · P90 $148 | 10,495 | Benchmark |
| Massachusetts | $94.81 | 1.03x | $74–$117 · P90 $155 | 7,660 | Benchmark |
| Rhode Island | $93.82 | 1.02x | $71–$99 · P90 $131 | 4,907 | Benchmark |
| Wyoming | $93.27 | 1.01x | $63–$101 · P90 $137 | 633 | Benchmark |
| Minnesota | $93.02 | 1.01x | $78–$117 · P90 $144 | 7,317 | Benchmark |
| Virginia | $88.85 | 0.96x | $77–$105 · P90 $155 | 31,781 | Benchmark |
| Pennsylvania | $88.59 | 0.96x | $76–$95 · P90 $122 | 54,278 | Benchmark |
| Delaware | $88.00 | 0.95x | $70–$103 · P90 $156 | 1,117 | Benchmark |
| District of Columbia | $85.84 | 0.93x | $74–$119 · P90 $150 | 1,901 | Benchmark |
| Maryland | $85.41 | 0.92x | $72–$104 · P90 $146 | 5,718 | Benchmark |
| Georgia | $85.19 | 0.92x | $73–$121 · P90 $177 | 91,186 | Benchmark |
| Iowa | $83.06 | 0.90x | $73–$116 · P90 $160 | 1,566 | Benchmark |
| South Carolina | $82.68 | 0.89x | $61–$94 · P90 $131 | 7,097 | Benchmark |
| Illinois | $82.02 | 0.89x | $70–$107 · P90 $194 | 14,743 | Benchmark |
| Indiana | $81.80 | 0.89x | $74–$96 · P90 $104 | 56,863 | Benchmark |
| Nebraska | $81.71 | 0.88x | $70–$113 · P90 $147 | 639 | Benchmark |
| Mississippi | $81.23 | 0.88x | $62–$105 · P90 $159 | 768 | Benchmark |
| Missouri | $80.98 | 0.88x | $62–$89 · P90 $125 | 55,326 | Benchmark |
| Arkansas | $80.08 | 0.87x | $63–$97 · P90 $137 | 1,206 | Benchmark |
| Alaska | $80.00 | 0.87x | $58–$106 · P90 $170 | 363 | Benchmark |
| Montana | $80.00 | 0.87x | $63–$113 · P90 $175 | 523 | Benchmark |
| Alabama | $80.00 | 0.87x | $60–$93 · P90 $140 | 2,705 | Benchmark |
| Michigan | $80.00 | 0.87x | $68–$97 · P90 $152 | 7,148 | Benchmark |
| South Dakota | $80.00 | 0.87x | $70–$117 · P90 $182 | 306 | Benchmark |
| Tennessee | $80.00 | 0.87x | $60–$95 · P90 $132 | 7,192 | Benchmark |
| Texas | $80.00 | 0.87x | $62–$103 · P90 $140 | 31,965 | Benchmark |
| Utah | $80.00 | 0.87x | $70–$109 · P90 $170 | 1,275 | Benchmark |
| Arizona | $80.00 | 0.87x | $61–$97 · P90 $160 | 4,209 | Benchmark |
| Washington | $80.00 | 0.87x | $60–$100 · P90 $172 | 3,920 | Benchmark |
| Louisiana | $80.00 | 0.87x | $66–$101 · P90 $151 | 1,649 | Benchmark |
| North Dakota | $80.00 | 0.87x | $70–$105 · P90 $138 | 398 | Benchmark |
| Kansas | $80.00 | 0.87x | $60–$94 · P90 $127 | 1,861 | Benchmark |
| Idaho | $80.00 | 0.87x | $61–$108 · P90 $177 | 699 | Benchmark |
| New Jersey | $80.00 | 0.87x | $58–$131 · P90 $157 | 19,883 | Benchmark |
| New Mexico | $80.00 | 0.87x | $65–$110 · P90 $159 | 1,149 | Benchmark |
| Nevada | $80.00 | 0.87x | $58–$101 · P90 $178 | 1,859 | Benchmark |
| Oklahoma | $80.00 | 0.87x | $65–$96 · P90 $137 | 1,354 | Benchmark |
| Oregon | $80.00 | 0.87x | $60–$112 · P90 $174 | 2,008 | Benchmark |
| Hawaii | $80.00 | 0.87x | $71–$98 · P90 $146 | 1,064 | Benchmark |
| Florida | $80.00 | 0.87x | $62–$94 · P90 $138 | 18,603 | Benchmark |
| California | $75.97 | 0.82x | $55–$117 · P90 $264 | 122,020 | Benchmark |
| Connecticut | $72.90 | 0.79x | $58–$123 · P90 $173 | 4,608 | Benchmark |
| New York | $70.35 | 0.76x | P75 $134 · P90 $188 | 211,674 | Benchmark |
| West Virginia | $69.84 | 0.76x | $57–$92 · P90 $105 | 2,076 | Benchmark |
| Ohio | $66.45 | 0.72x | $48–$95 · P90 $146 | 78,828 | Benchmark |
| Kentucky | $60.00 | 0.65x | $41–$80 · P90 $100 | 25,669 | Benchmark |
| North Carolina | $57.62 | 0.62x | $58–$94 · P90 $140 | 99,233 | 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 99213. Reddenda. https://reddenda.health/code/99213/
Derivation federally mandated TiC MRFs, verified to provider identity1,076,293 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0