HCPCS 99213

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

Evaluation and management Work RVU per service 1.30 (2021 fee schedule)

455,329
100th percentile among 6,253 codes billed · 2021
$4.58B
100th percentile among 6,253 codes billed · 2021
74.6M
100th percentile among 6,253 codes billed · 2021
80
84th percentile among 6,253 codes billed · 2021
590
83rd percentile among 6,253 codes billed · 2021
+25.7%
Medicare payment on the code vs 2020; billers +2.8% · 2021

Trend

Medicare payment on the code

$0$2.00B$4.00B2020: $3.64B paid20202021: $4.58B paid20212022: $4.32B paid20222023: $4.12B paid20232024: $3.97B paid2024$3.97B$0$2.00B$4.00B2020: $3.64B paid20202021: $4.58B paid20212022: $4.32B paid20222023: $4.12B paid20232024: $3.97B paid2024$3.97B$0$2.00B$4.00B2020: $3.64B paid20202021: $4.58B paid20212022: $4.32B paid20222023: $4.12B paid20232024: $3.97B paid2024$3.97B$0$2.00B$4.00B2020: $3.64B paid20202021: $4.58B paid20212022: $4.32B paid20222023: $4.12B paid20232024: $3.97B paid2024$3.97B

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

Billers

0200K400K2020: 443K providers20202021: 455K providers20212022: 456K providers20222023: 457K providers20232024: 458K providers2024458K0200K400K2020: 443K providers20202021: 455K providers20212022: 456K providers20222023: 457K providers20232024: 458K providers2024458K0200K400K2020: 443K providers20202021: 455K providers20212022: 456K providers20222023: 457K providers20232024: 458K providers2024458K0200K400K2020: 443K providers20202021: 455K providers20212022: 456K providers20222023: 457K providers20232024: 458K providers2024458K

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
2024457,569$3,967,726,634-4%67,927,936725331.30
2023457,151$4,123,102,926-4%70,165,439755501.30
2022455,642$4,316,975,149-6%72,368,685775701.30
2021455,329$4,578,684,345+26%74,572,954805901.30
2020442,931$3,641,690,420first year in data74,817,627826060.97

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
California33,869$480,551,1537,021,56884791
New York31,621$409,110,9295,628,76484664
Florida29,388$407,059,6966,359,86293849
Texas28,812$284,980,9654,752,09182588
New Jersey13,756$195,903,6762,784,946103712
Pennsylvania22,542$186,052,3813,071,42670472
Illinois17,691$169,890,6682,736,12978551
Ohio19,702$147,176,9402,689,06876462
North Carolina16,373$137,925,0732,403,02875508
Virginia12,201$136,638,3842,230,83296641
Georgia13,124$135,687,0772,303,16489622
Maryland9,301$128,458,3901,943,287102765
Massachusetts13,560$127,121,2591,986,84173521
Michigan15,047$115,465,0551,964,51567455
Tennessee11,049$100,824,7321,825,50088562

Not listed: 58 billers with an armed-forces or unknown state code (AA, AE, AP, XX, ZZ); they are in the national totals.

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2021.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ29,895$469,886,8766,194,71098
Los Angeles-Long Beach-Anaheim, CA11,896$179,437,6202,534,85681
Chicago-Naperville-Elgin, IL-IN13,286$131,487,4362,064,78675
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD10,418$108,949,0121,677,39680
Washington-Arlington-Alexandria, DC-VA-MD-WV7,757$98,158,7441,422,46186
Miami-Fort Lauderdale-West Palm Beach, FL7,443$97,797,8571,448,98480
Boston-Cambridge-Newton, MA-NH9,868$90,043,2201,389,49371
Dallas-Fort Worth-Arlington, TX7,914$74,779,2511,224,06882
Detroit-Warren-Dearborn, MI6,605$64,108,1021,023,42279
Phoenix-Mesa-Chandler, AZ6,254$62,363,4561,033,57973
Atlanta-Sandy Springs-Roswell, GA6,892$62,183,6911,021,35977
Houston-Pasadena-The Woodlands, TX6,846$58,359,643930,34966
Baltimore-Columbia-Towson, MD4,922$57,536,389888,52586
San Francisco-Oakland-Fremont, CA4,130$52,966,709726,14276
Tampa-St. Petersburg-Clearwater, FL4,534$47,220,847757,58478

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 2021.

Specialties billing 99213 nationally

Internal Medicine accounts for 12% of payment for 99213 nationally in 2021, across 72 specialties on claims.

observed calculated calculated calculated calculated calculated
Internal Medicine45,40610.0%$557,854,41612%8,918,804196
Family Practice59,59313%$554,880,81712%9,399,634158
Nurse Practitioner77,87517%$437,001,6739.5%8,555,770110
Dermatology11,3092.5%$357,746,7057.8%5,587,931494
Physician Assistant46,89210%$313,431,8456.8%5,876,698125
Podiatry13,1832.9%$302,693,3946.6%4,430,848336
Orthopedic Surgery19,0274.2%$266,637,9135.8%4,009,916211
Urology8,2031.8%$164,836,7433.6%2,544,919310
Ophthalmology10,2932.3%$164,542,2653.6%2,534,485246
Cardiology12,1202.7%$149,570,5523.3%2,322,736192
Otolaryngology7,8881.7%$120,167,8952.6%1,797,301228
Psychiatry7,7631.7%$92,629,5512.0%1,512,528195
Hematology-Oncology6,2381.4%$92,483,8022.0%1,467,798235
Optometry16,6553.7%$90,359,7512.0%1,502,59690
Gastroenterology9,9252.2%$76,313,4941.7%1,138,679115

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 2021.

Top billers of 99213 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