HCPCS 99231
Evaluation and management service (ClaimLight category; the code descriptor is not shown)
Evaluation and management Work RVU per service 0.76 (2021 fee schedule)
Trend
Medicare payment on the code
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.
Billers
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 | |
|---|---|---|---|---|---|---|---|
| 2024 | 44,310 | $125,911,678 | -14% | 3,401,229 | 36 | 238 | 1.00 |
| 2023 | 50,953 | $145,902,046 | +27% | 3,859,427 | 37 | 236 | 1.00 |
| 2022 | 48,611 | $114,583,620 | -11% | 3,845,337 | 38 | 248 | 0.76 |
| 2021 | 51,572 | $128,727,158 | -16% | 4,301,647 | 39 | 267 | 0.76 |
| 2020 | 56,563 | $152,646,896 | first year in data | 4,925,381 | 39 | 284 | 0.76 |
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 York | 3,861 | $10,172,783 | 309,763 | 40 | 255 | |
| Florida | 3,201 | $9,542,922 | 315,864 | 42 | 369 | |
| Texas | 2,866 | $8,630,116 | 292,891 | 39 | 329 | |
| Pennsylvania | 3,039 | $8,309,676 | 278,914 | 39 | 310 | |
| California | 2,292 | $7,910,241 | 247,109 | 39 | 316 | |
| New Jersey | 1,644 | $5,398,207 | 168,801 | 45 | 391 | |
| Michigan | 2,152 | $5,306,215 | 174,704 | 40 | 288 | |
| Massachusetts | 1,740 | $5,238,453 | 169,559 | 44 | 334 | |
| Illinois | 2,225 | $5,076,804 | 165,585 | 37 | 226 | |
| Ohio | 2,304 | $4,466,617 | 155,719 | 35 | 216 | |
| Virginia | 1,610 | $3,324,398 | 111,414 | 38 | 211 | |
| Missouri | 1,602 | $3,305,873 | 114,356 | 38 | 229 | |
| Indiana | 1,441 | $3,151,998 | 111,920 | 38 | 276 | |
| Tennessee | 1,228 | $3,134,621 | 112,034 | 38 | 304 | |
| Kentucky | 1,020 | $2,945,002 | 103,017 | 43 | 304 |
Not listed: 12 billers with an armed-forces or unknown state code (AE, AP, ZZ); they are in the national totals.
Not listed: 2 states 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 2021.
Top metro areas
| observed | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|
| New York-Newark-Jersey City, NY-NJ | 3,522 | $11,229,939 | 333,285 | 43 | |
| Los Angeles-Long Beach-Anaheim, CA | 755 | $4,506,546 | 140,853 | 44 | |
| Chicago-Naperville-Elgin, IL-IN | 1,684 | $4,397,649 | 143,294 | 38 | |
| Philadelphia-Camden-Wilmington, PA-NJ-DE-MD | 1,579 | $4,204,074 | 136,391 | 38 | |
| Boston-Cambridge-Newton, MA-NH | 1,262 | $3,747,282 | 120,360 | 43 | |
| Detroit-Warren-Dearborn, MI | 1,133 | $3,400,686 | 109,767 | 46 | |
| Dallas-Fort Worth-Arlington, TX | 771 | $2,437,513 | 83,012 | 40 | |
| Miami-Fort Lauderdale-West Palm Beach, FL | 613 | $2,336,788 | 73,455 | 43 | |
| Houston-Pasadena-The Woodlands, TX | 677 | $2,043,123 | 67,430 | 39 | |
| St. Louis, MO-IL | 828 | $1,731,697 | 58,607 | 36 | |
| Washington-Arlington-Alexandria, DC-VA-MD-WV | 634 | $1,712,544 | 52,594 | 36 | |
| Pittsburgh, PA | 714 | $1,624,985 | 55,391 | 37 | |
| Tampa-St. Petersburg-Clearwater, FL | 420 | $1,445,416 | 47,708 | 44 | |
| Memphis, TN-MS-AR | 252 | $1,243,427 | 43,944 | 51 | |
| Jacksonville, FL | 437 | $1,189,916 | 41,831 | 47 |
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 99231 nationally
Internal Medicine accounts for 14% of payment for 99231 nationally in 2021, across 56 specialties on claims.
| observed | calculated | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|---|
| Internal Medicine | 6,543 | 13% | $17,809,628 | 14% | 577,654 | 88 |
| Psychiatry | 3,195 | 6.2% | $16,602,803 | 13% | 540,845 | 169 |
| Nurse Practitioner | 6,443 | 12% | $13,271,186 | 10% | 514,427 | 80 |
| Physical Medicine and Rehabilitation | 1,270 | 2.5% | $11,342,290 | 8.8% | 374,668 | 295 |
| General Surgery | 5,115 | 9.9% | $9,002,630 | 7.0% | 294,794 | 58 |
| Physician Assistant | 3,357 | 6.5% | $5,211,358 | 4.0% | 200,132 | 60 |
| Hospitalist | 2,867 | 5.6% | $5,075,746 | 3.9% | 165,043 | 58 |
| Cardiology | 2,119 | 4.1% | $5,070,809 | 3.9% | 164,345 | 78 |
| Family Practice | 2,136 | 4.1% | $5,064,937 | 3.9% | 169,170 | 79 |
| Gastroenterology | 2,351 | 4.6% | $4,919,504 | 3.8% | 158,365 | 67 |
| Infectious Disease | 1,326 | 2.6% | $4,693,404 | 3.6% | 150,144 | 113 |
| Nephrology | 1,832 | 3.6% | $4,465,946 | 3.5% | 144,919 | 79 |
| Neurology | 1,457 | 2.8% | $3,275,723 | 2.5% | 106,756 | 73 |
| Urology | 1,765 | 3.4% | $3,212,863 | 2.5% | 103,884 | 59 |
| Pulmonary Disease | 894 | 1.7% | $2,520,785 | 2.0% | 81,547 | 91 |
Not listed: 17 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 99231 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