HCPCS 99212

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

Evaluation and management Work RVU per service 0.70 (2023 fee schedule)

99,011
100th percentile among 6,405 codes billed · 2023
$241M
99th percentile among 6,405 codes billed · 2023
6.4M
99th percentile among 6,405 codes billed · 2023
31
60th percentile among 6,405 codes billed · 2023
218
69th percentile among 6,405 codes billed · 2023
-13.5%
Medicare payment on the code vs 2022; billers -9.7% · 2023

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 York7,854$28,175,913635,13533299
California7,971$27,261,245646,51832283
Florida6,918$20,391,575529,21136267
New Jersey3,453$12,329,113287,14336310
Texas5,514$12,219,828340,64231204
Pennsylvania4,721$10,701,822293,39631203
Illinois3,951$9,571,555257,78032214
Ohio4,099$6,978,491213,19329163
Virginia2,825$6,591,764178,96831207
Massachusetts2,655$6,351,431166,21831206
Maryland2,363$6,306,246158,41632233
North Carolina2,886$6,016,805174,78432194
Georgia2,717$5,712,528163,96931196
Arizona2,307$5,422,480149,93332230
Michigan2,750$5,381,076149,04030169

Not listed: 9 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 2023.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ8,173$32,925,969720,66335
Los Angeles-Long Beach-Anaheim, CA2,601$10,554,123242,83334
Chicago-Naperville-Elgin, IL-IN2,918$7,476,103195,97432
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD2,209$6,443,903161,54935
Miami-Fort Lauderdale-West Palm Beach, FL1,693$5,423,859133,34134
Washington-Arlington-Alexandria, DC-VA-MD-WV1,755$4,413,969106,22630
Boston-Cambridge-Newton, MA-NH1,848$4,066,035103,47129
Phoenix-Mesa-Chandler, AZ1,457$3,255,75788,50231
San Francisco-Oakland-Fremont, CA1,000$3,230,37871,78533
Dallas-Fort Worth-Arlington, TX1,457$3,153,05086,41530
Detroit-Warren-Dearborn, MI1,222$3,011,60678,75734
Baltimore-Columbia-Towson, MD1,214$3,009,92376,14132
Atlanta-Sandy Springs-Roswell, GA1,377$2,643,73773,08428
Houston-Pasadena-The Woodlands, TX1,142$2,274,68861,13329
San Diego-Chula Vista-Carlsbad, CA631$2,174,09351,46829

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 2023.

Specialties billing 99212 nationally

Dermatology accounts for 16% of payment for 99212 nationally in 2023, across 65 specialties on claims.

observed calculated calculated calculated calculated calculated
Dermatology8,2768.4%$38,222,25016%966,828117
Podiatry6,9537.0%$36,176,79515%879,186126
Nurse Practitioner13,83914%$21,511,8998.9%706,86351
Physician Assistant12,15212%$20,591,6768.5%638,99953
Internal Medicine7,0717.1%$17,003,4247.1%425,94360
Orthopedic Surgery5,8625.9%$14,131,2955.9%365,60862
Family Practice7,3297.4%$12,588,4625.2%339,16046
Optometry6,1976.3%$9,337,6003.9%258,13542
Ophthalmology3,2263.3%$9,046,1873.8%234,10473
General Surgery3,7813.8%$6,607,0772.7%182,52948
Urology2,4462.5%$6,122,6292.5%154,95463
Otolaryngology2,5902.6%$6,089,0992.5%157,12361
Psychiatry9080.92%$4,519,7131.9%122,736135
Cardiology1,1601.2%$3,089,1161.3%77,28167
Obstetrics & Gynecology2,1712.2%$2,825,2611.2%74,23234

Not listed: 11 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 2023.

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