Code Reality Check
99214 reimbursement rate: Office visit, established patient, 30-39 min
Office visit, established patient, 30-39 min (CPT 99214) pays a median $204.45 in Wisconsin and $36.40 in New York, against a Medicare anchor of $131.77. 51 of 51 states clear the publication floor.
spread 5.6x top to bottom
Medicare anchor $131.77
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $204.45 | 1.55x | $122–$287 · P90 $331 | 41,217 | Benchmark |
| Colorado | $151.13 | 1.15x | $115–$249 · P90 $249 | 9,673 | Benchmark |
| Minnesota | $140.63 | 1.07x | $115–$177 · P90 $204 | 8,146 | Benchmark |
| Washington | $132.65 | 1.01x | $106–$246 · P90 $279 | 11,210 | Benchmark |
| New Hampshire | $132.62 | 1.01x | $129–$185 · P90 $255 | 7,278 | Benchmark |
| Massachusetts | $129.31 | 0.98x | $97–$169 · P90 $279 | 6,925 | Benchmark |
| Maine | $129.27 | 0.98x | $103–$184 · P90 $245 | 10,291 | Benchmark |
| District of Columbia | $125.90 | 0.96x | $107–$172 · P90 $218 | 1,939 | Benchmark |
| Virginia | $125.27 | 0.95x | $112–$147 · P90 $196 | 26,678 | Benchmark |
| Pennsylvania | $124.93 | 0.95x | $108–$138 · P90 $178 | 55,817 | Benchmark |
| Delaware | $124.71 | 0.95x | $96–$146 · P90 $223 | 1,215 | Benchmark |
| South Carolina | $123.19 | 0.93x | $90–$143 · P90 $173 | 7,218 | Benchmark |
| Iowa | $122.17 | 0.93x | $103–$164 · P90 $247 | 1,618 | Benchmark |
| Georgia | $121.40 | 0.92x | $97–$150 · P90 $243 | 94,946 | Benchmark |
| Rhode Island | $120.25 | 0.91x | $104–$140 · P90 $201 | 4,920 | Benchmark |
| Maryland | $116.12 | 0.88x | $101–$143 · P90 $218 | 5,712 | Benchmark |
| North Carolina | $115.73 | 0.88x | $85–$143 · P90 $181 | 99,490 | Benchmark |
| Tennessee | $115.04 | 0.87x | $87–$143 · P90 $195 | 7,254 | Benchmark |
| Utah | $115.00 | 0.87x | $101–$143 · P90 $245 | 1,335 | Benchmark |
| Alabama | $115.00 | 0.87x | $89–$132 · P90 $191 | 2,865 | Benchmark |
| Arizona | $115.00 | 0.87x | $88–$143 · P90 $242 | 4,354 | Benchmark |
| Florida | $115.00 | 0.87x | $85–$136 · P90 $205 | 19,205 | Benchmark |
| Hawaii | $115.00 | 0.87x | $101–$143 · P90 $223 | 1,095 | Benchmark |
| Idaho | $115.00 | 0.87x | $101–$150 · P90 $253 | 769 | Benchmark |
| Illinois | $115.00 | 0.87x | $88–$142 · P90 $258 | 14,588 | Benchmark |
| Louisiana | $115.00 | 0.87x | $88–$143 · P90 $235 | 1,740 | Benchmark |
| Michigan | $115.00 | 0.87x | $90–$140 · P90 $240 | 7,473 | Benchmark |
| Mississippi | $115.00 | 0.87x | $90–$143 · P90 $243 | 765 | Benchmark |
| Montana | $115.00 | 0.87x | $89–$158 · P90 $258 | 562 | Benchmark |
| North Dakota | $115.00 | 0.87x | $101–$148 · P90 $202 | 416 | Benchmark |
| Nebraska | $115.00 | 0.87x | $93–$152 · P90 $213 | 680 | Benchmark |
| New Mexico | $115.00 | 0.87x | $88–$146 · P90 $256 | 1,154 | Benchmark |
| Nevada | $115.00 | 0.87x | $86–$143 · P90 $239 | 1,892 | Benchmark |
| Oklahoma | $115.00 | 0.87x | $93–$143 · P90 $214 | 1,417 | Benchmark |
| Oregon | $115.00 | 0.87x | $91–$160 · P90 $278 | 2,278 | Benchmark |
| South Dakota | $115.00 | 0.87x | $101–$146 · P90 $258 | 330 | Benchmark |
| Texas | $115.00 | 0.87x | $93–$149 · P90 $219 | 32,365 | Benchmark |
| Alaska | $115.00 | 0.87x | $85–$164 · P90 $249 | 425 | Benchmark |
| Arkansas | $114.98 | 0.87x | $88–$143 · P90 $191 | 1,264 | Benchmark |
| Indiana | $114.86 | 0.87x | $107–$135 · P90 $159 | 56,008 | Benchmark |
| New Jersey | $111.07 | 0.84x | $60–$165 · P90 $236 | 20,632 | Benchmark |
| Wyoming | $109.12 | 0.83x | $104–$144 · P90 $198 | 643 | Benchmark |
| Connecticut | $105.38 | 0.80x | P75 $170 · P90 $279 | 4,724 | Benchmark |
| Kansas | $104.25 | 0.79x | $86–$131 · P90 $182 | 1,882 | Benchmark |
| California | $101.22 | 0.77x | $77–$164 · P90 $398 | 142,824 | Benchmark |
| Missouri | $97.79 | 0.74x | $88–$126 · P90 $175 | 52,119 | Benchmark |
| Vermont | $89.45 | 0.68x | P75 $129 · P90 $215 | 1,292 | Benchmark |
| West Virginia | $85.15 | 0.65x | $61–$125 · P90 $150 | 2,329 | Benchmark |
| Ohio | $83.22 | 0.63x | $61–$124 · P90 $219 | 98,210 | Benchmark |
| Kentucky | $79.51 | 0.60x | $59–$116 · P90 $147 | 25,508 | Benchmark |
| New York | $36.40 | 0.28x | P75 $163 · P90 $279 | 228,643 | 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 99214. Reddenda. https://reddenda.health/code/99214/
Derivation federally mandated TiC MRFs, verified to provider identity1,133,333 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0