Code Reality Check
99215 reimbursement rate: Office visit, established patient, 40-54 min
Office visit, established patient, 40-54 min (CPT 99215) pays a median $256.52 in Wisconsin and $119.30 in Kentucky, against a Medicare anchor of $186.18. 51 of 51 states clear the publication floor.
spread 2.2x top to bottom
Medicare anchor $186.18
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $256.52 | 1.38x | $141–$403 · P90 $471 | 44,143 | Benchmark |
| District of Columbia | $232.87 | 1.25x | $142–$233 · P90 $326 | 1,625 | Benchmark |
| Colorado | $221.28 | 1.19x | $161–$361 · P90 $467 | 9,377 | Benchmark |
| Minnesota | $219.41 | 1.18x | $155–$272 · P90 $366 | 8,642 | Benchmark |
| Maine | $190.39 | 1.02x | $150–$274 · P90 $345 | 10,164 | Benchmark |
| New Hampshire | $186.80 | 1.00x | $182–$242 · P90 $328 | 5,416 | Benchmark |
| Iowa | $182.87 | 0.98x | $137–$230 · P90 $340 | 1,651 | Benchmark |
| Massachusetts | $181.51 | 0.97x | $125–$254 · P90 $408 | 6,865 | Benchmark |
| Wyoming | $179.58 | 0.96x | $147–$203 · P90 $284 | 628 | Benchmark |
| North Dakota | $179.00 | 0.96x | $125–$231 · P90 $319 | 337 | Benchmark |
| Virginia | $177.44 | 0.95x | $142–$233 · P90 $297 | 25,176 | Benchmark |
| Rhode Island | $177.03 | 0.95x | $154–$196 · P90 $225 | 4,924 | Benchmark |
| Maryland | $176.81 | 0.95x | $125–$233 · P90 $316 | 5,129 | Benchmark |
| Hawaii | $176.22 | 0.95x | $125–$224 · P90 $366 | 860 | Benchmark |
| South Carolina | $175.99 | 0.95x | $125–$205 · P90 $266 | 6,964 | Benchmark |
| Pennsylvania | $174.02 | 0.93x | $140–$204 · P90 $274 | 27,374 | Benchmark |
| Delaware | $173.95 | 0.93x | $125–$209 · P90 $312 | 975 | Benchmark |
| Montana | $171.59 | 0.92x | $125–$227 · P90 $475 | 528 | Benchmark |
| Indiana | $171.31 | 0.92x | $141–$179 · P90 $220 | 58,455 | Benchmark |
| Georgia | $169.27 | 0.91x | $135–$239 · P90 $352 | 89,783 | Benchmark |
| Tennessee | $166.19 | 0.89x | $125–$203 · P90 $291 | 7,067 | Benchmark |
| Illinois | $165.86 | 0.89x | $136–$206 · P90 $406 | 14,804 | Benchmark |
| Utah | $164.38 | 0.88x | $125–$234 · P90 $412 | 1,180 | Benchmark |
| Idaho | $164.28 | 0.88x | $118–$221 · P90 $353 | 737 | Benchmark |
| South Dakota | $163.41 | 0.88x | $125–$223 · P90 $419 | 283 | Benchmark |
| Alabama | $163.07 | 0.88x | $125–$187 · P90 $287 | 2,730 | Benchmark |
| Missouri | $162.24 | 0.87x | $130–$180 · P90 $273 | 54,235 | Benchmark |
| Arkansas | $162.17 | 0.87x | $125–$205 · P90 $285 | 1,337 | Benchmark |
| Oklahoma | $162.17 | 0.87x | $125–$208 · P90 $287 | 1,327 | Benchmark |
| Texas | $161.92 | 0.87x | $125–$208 · P90 $309 | 31,010 | Benchmark |
| Alaska | $159.79 | 0.86x | $125–$211 · P90 $356 | 395 | Benchmark |
| Nebraska | $159.59 | 0.86x | $123–$231 · P90 $313 | 592 | Benchmark |
| Oregon | $159.35 | 0.86x | $125–$232 · P90 $421 | 2,080 | Benchmark |
| Washington | $158.14 | 0.85x | $124–$226 · P90 $423 | 3,828 | Benchmark |
| Mississippi | $157.66 | 0.85x | $120–$205 · P90 $349 | 809 | Benchmark |
| New Mexico | $155.77 | 0.84x | $123–$221 · P90 $364 | 1,097 | Benchmark |
| Louisiana | $153.79 | 0.83x | $118–$217 · P90 $352 | 1,617 | Benchmark |
| Michigan | $153.41 | 0.82x | $125–$205 · P90 $353 | 6,738 | Benchmark |
| Kansas | $150.00 | 0.81x | $123–$196 · P90 $285 | 1,922 | Benchmark |
| Arizona | $149.07 | 0.80x | $120–$210 · P90 $365 | 4,198 | Benchmark |
| Florida | $147.81 | 0.79x | $123–$204 · P90 $302 | 17,980 | Benchmark |
| Nevada | $145.19 | 0.78x | $123–$211 · P90 $409 | 1,855 | Benchmark |
| New Jersey | $144.62 | 0.78x | $112–$234 · P90 $330 | 19,210 | Benchmark |
| California | $140.80 | 0.76x | $118–$270 · P90 $533 | 149,701 | Benchmark |
| North Carolina | $134.35 | 0.72x | $125–$205 · P90 $266 | 99,069 | Benchmark |
| Connecticut | $126.11 | 0.68x | $105–$229 · P90 $381 | 4,692 | Benchmark |
| West Virginia | $125.00 | 0.67x | $101–$165 · P90 $216 | 2,159 | Benchmark |
| Ohio | $125.00 | 0.67x | $98–$184 · P90 $272 | 99,578 | Benchmark |
| Vermont | $123.54 | 0.66x | P75 $182 · P90 $276 | 1,079 | Benchmark |
| New York | $122.08 | 0.66x | P75 $208 · P90 $397 | 232,797 | Benchmark |
| Kentucky | $119.30 | 0.64x | $95–$168 · P90 $207 | 22,138 | 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 99215. Reddenda. https://reddenda.health/code/99215/
Derivation federally mandated TiC MRFs, verified to provider identity1,097,260 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0