HCPCS 99291

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

Evaluation and management Work RVU per service 4.50 (2024 fee schedule)

73,484
100th percentile among 6,471 codes billed · 2024
$897M
100th percentile among 6,471 codes billed · 2024
5.5M
99th percentile among 6,471 codes billed · 2024
44
69th percentile among 6,471 codes billed · 2024
234
69th percentile among 6,471 codes billed · 2024
-0.6%
Medicare payment on the code vs 2023; billers +3.1% · 2024

Trend

Medicare payment on the code

$0$500M$1.00B2020: $1.10B paid20202021: $1.06B paid20212022: $963M paid20222023: $903M paid20232024: $897M paid2024$897M$0$500M$1.00B2020: $1.10B paid20202021: $1.06B paid20212022: $963M paid20222023: $903M paid20232024: $897M paid2024$897M$0$500M$1.00B2020: $1.10B paid20202021: $1.06B paid20212022: $963M paid20222023: $903M paid20232024: $897M paid2024$897M$0$500M$1.00B2020: $1.10B paid20202021: $1.06B paid20212022: $963M paid20222023: $903M paid20232024: $897M paid2024$897M

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

Billers

050K2020: 68K providers20202021: 69K providers20212022: 69K providers20222023: 71K providers20232024: 73K providers202473K050K2020: 68K providers20202021: 69K providers20212022: 69K providers20222023: 71K providers20232024: 73K providers202473K050K2020: 68K providers20202021: 69K providers20212022: 69K providers20222023: 71K providers20232024: 73K providers202473K050K2020: 68K providers20202021: 69K providers20212022: 69K providers20222023: 71K providers20232024: 73K providers202473K

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
202473,484$897,202,650-1%5,457,118442344.50
202371,290$902,779,510-6%5,326,011442354.50
202269,374$962,823,942-9%5,379,608452504.50
202169,264$1,062,688,965-3%5,807,747472824.50
202068,223$1,097,626,171first year in data5,952,087473024.50

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
California7,543$136,414,426799,56859354
Florida4,936$76,057,513454,55253307
New York4,739$68,381,521382,44344269
Texas4,877$66,029,167410,79047284
Pennsylvania3,835$43,622,508267,09643208
Illinois3,116$39,122,277231,16044231
New Jersey2,104$32,336,151186,23050277
Ohio3,180$30,951,119195,26639176
Massachusetts2,213$27,238,195162,31751206
Michigan2,770$26,438,839161,40437173
Maryland1,687$25,173,264148,38555277
North Carolina2,660$23,206,249150,05338156
Georgia2,289$22,851,505143,03842180
Virginia1,973$22,760,898140,76149199
Missouri1,513$16,738,128106,51447201

Not listed: 20 billers with an armed-forces or unknown state code (AA, 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 2024.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ5,108$81,120,975450,62048
Los Angeles-Long Beach-Anaheim, CA2,688$62,246,924365,41072
Chicago-Naperville-Elgin, IL-IN2,550$34,317,014202,27147
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD1,806$24,780,710146,92750
Miami-Fort Lauderdale-West Palm Beach, FL1,346$22,149,266128,02952
Houston-Pasadena-The Woodlands, TX1,286$19,973,128122,11756
Boston-Cambridge-Newton, MA-NH1,503$19,583,659115,39153
Washington-Arlington-Alexandria, DC-VA-MD-WV1,326$19,474,167113,46852
Dallas-Fort Worth-Arlington, TX1,356$16,491,657102,85046
Baltimore-Columbia-Towson, MD1,105$15,877,20593,72855
Detroit-Warren-Dearborn, MI1,376$14,736,71289,24041
San Francisco-Oakland-Fremont, CA984$14,636,79381,09749
Atlanta-Sandy Springs-Roswell, GA1,355$12,930,00580,44743
Riverside-San Bernardino-Ontario, CA784$12,850,87876,66154
Phoenix-Mesa-Chandler, AZ902$11,942,88074,66146

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 2024.

Specialties billing 99291 nationally

Emergency Medicine accounts for 30% of payment for 99291 nationally in 2024, across 37 specialties on claims.

observed calculated calculated calculated calculated calculated
Emergency Medicine31,27043%$266,022,96830%1,606,75051
Pulmonary Disease6,5738.9%$168,666,44019%1,015,106154
Critical Care (Intensivists)4,2865.8%$118,417,04413%704,624164
Internal Medicine6,9689.5%$97,166,18511%586,94784
Nurse Practitioner5,2537.1%$37,827,1464.2%271,92152
Neurology2,0722.8%$31,516,9403.5%188,23091
General Surgery2,2033.0%$25,297,6202.8%150,95369
Cardiology1,9102.6%$24,752,1362.8%144,44276
Hospitalist2,7043.7%$23,508,1012.6%144,48453
Physician Assistant3,6715.0%$20,055,3212.2%142,43639
Anesthesiology1,2301.7%$19,759,7662.2%116,89995
Nephrology1,1301.5%$14,694,3121.6%87,49477
Family Practice1,7032.3%$14,239,5721.6%88,40252
Infectious Disease4870.66%$8,820,5130.98%52,611108
Advanced Heart Failure and Transplant Cardiology4070.55%$6,475,1520.72%37,69193

Not listed: 27 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 2024.

Top billers of 99291 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