HCPCS 99212

Evaluation and management service (ClaimLight category; the code descriptor is not shown)

Evaluation and management Work RVU per service 0.70 (2022 fee schedule)

109,666
100th percentile among 6,326 codes billed · 2022
$279M
99th percentile among 6,326 codes billed · 2022
7.3M
99th percentile among 6,326 codes billed · 2022
32
62nd percentile among 6,326 codes billed · 2022
223
70th percentile among 6,326 codes billed · 2022
-13.0%
Medicare payment on the code vs 2021; billers -10.7% · 2022

Trend

Medicare payment on the code

$0$200M2020: $234M paid20202021: $320M paid20212022: $279M paid20222023: $241M paid20232024: $216M paid2024$216M$0$200M2020: $234M paid20202021: $320M paid20212022: $279M paid20222023: $241M paid20232024: $216M paid2024$216M$0$200M2020: $234M paid20202021: $320M paid20212022: $279M paid20222023: $241M paid20232024: $216M paid2024$216M$0$200M2020: $234M paid20202021: $320M paid20212022: $279M paid20222023: $241M paid20232024: $216M paid2024$216M

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

Billers

050K100K2020: 111K providers20202021: 123K providers20212022: 110K providers20222023: 99K providers20232024: 91K providers202491K050K100K2020: 111K providers20202021: 123K providers20212022: 110K providers20222023: 99K providers20232024: 91K providers202491K050K100K2020: 111K providers20202021: 123K providers20212022: 110K providers20222023: 99K providers20232024: 91K providers202491K050K100K2020: 111K providers20202021: 123K providers20212022: 110K providers20222023: 99K providers20232024: 91K providers202491K

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

observed calculated calculated calculated calculated calculated reported
202490,889$216,133,383-10%5,819,455312120.70
202399,011$241,099,250-13%6,440,114312180.70
2022109,666$278,584,010-13%7,292,614322230.70
2021122,768$320,057,140+37%8,331,445322340.70
2020111,120$233,953,402first year in data7,752,244322410.48

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

By state

observed calculated calculated calculated calculated calculated
New York8,923$36,842,659780,55738307
California8,602$30,088,989712,58532289
Florida7,413$22,903,936582,67336267
New Jersey3,934$14,118,905317,92837307
Texas5,965$13,625,114377,98031212
Pennsylvania5,132$12,288,564329,10431210
Illinois4,402$10,579,458281,47732214
Ohio4,520$7,875,012235,37928162
Maryland2,673$7,517,024185,14532229
Virginia3,249$7,316,152195,27631200
North Carolina3,425$7,095,896202,24431194
Massachusetts2,881$7,028,632180,39431213
Georgia3,126$6,795,127192,50731199
Michigan3,066$6,374,338174,13530186
Arizona2,377$5,772,623160,04832230

Not listed: 7 billers with an armed-forces or unknown state code (AE, AP, XX, ZZ); they are in the national totals.

Not listed: 1 state with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2022.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ9,329$41,942,536863,66440
Los Angeles-Long Beach-Anaheim, CA2,859$11,620,829264,15534
Chicago-Naperville-Elgin, IL-IN3,263$8,150,642210,42532
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD2,452$7,337,302178,99034
Miami-Fort Lauderdale-West Palm Beach, FL1,772$6,284,385149,37335
Washington-Arlington-Alexandria, DC-VA-MD-WV1,952$5,518,836129,77331
Boston-Cambridge-Newton, MA-NH2,012$4,516,409113,96229
Detroit-Warren-Dearborn, MI1,411$3,621,51792,85132
Dallas-Fort Worth-Arlington, TX1,575$3,526,06196,01830
San Francisco-Oakland-Fremont, CA1,102$3,483,88977,92533
Phoenix-Mesa-Chandler, AZ1,502$3,455,75594,18931
Baltimore-Columbia-Towson, MD1,377$3,372,77483,95031
Atlanta-Sandy Springs-Roswell, GA1,571$3,197,85386,77629
Houston-Pasadena-The Woodlands, TX1,225$2,532,76667,64028
Tampa-St. Petersburg-Clearwater, FL944$2,319,37360,55932

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 100 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2022.

Specialties billing 99212 nationally

Podiatry accounts for 15% of payment for 99212 nationally in 2022, across 67 specialties on claims.

observed calculated calculated calculated calculated calculated
Podiatry7,3436.7%$40,604,14415%974,060133
Dermatology8,2757.5%$39,905,98714%1,009,460122
Nurse Practitioner16,03515%$25,728,5829.2%805,41850
Physician Assistant12,89412%$24,017,6348.6%700,71854
Internal Medicine8,2707.5%$21,144,7057.6%518,82963
Family Practice9,0958.3%$17,104,2266.1%442,71749
Orthopedic Surgery6,3775.8%$16,522,0965.9%422,32966
Ophthalmology3,4633.2%$10,087,4893.6%260,51675
Optometry6,4535.9%$9,741,6513.5%271,66642
Urology2,6842.4%$7,437,3202.7%186,83970
General Surgery3,8123.5%$7,192,1912.6%198,32452
Otolaryngology2,8742.6%$7,101,2172.5%182,25963
Psychiatry1,0010.91%$5,054,1681.8%137,042137
Cardiology1,4001.3%$3,886,0561.4%98,23070
Emergency Medicine1,1461.0%$3,697,7261.3%74,53465

Not listed: 8 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2022.

Top billers of 99212 nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations