HCPCS 99309

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

Evaluation and management Work RVU per service 1.55 (2020 fee schedule)

26,044
99th percentile among 6,116 codes billed · 2020
$646M
100th percentile among 6,116 codes billed · 2020
9.7M
99th percentile among 6,116 codes billed · 2020
172
91st percentile among 6,116 codes billed · 2020
1,351
91st percentile among 6,116 codes billed · 2020

Trend

Medicare payment on the code

$0$500M$1.00B2020: $646M paid20202021: $641M paid20212022: $685M paid20222023: $924M paid20232024: $1.10B paid2024$1.10B$0$500M$1.00B2020: $646M paid20202021: $641M paid20212022: $685M paid20222023: $924M paid20232024: $1.10B paid2024$1.10B$0$500M$1.00B2020: $646M paid20202021: $641M paid20212022: $685M paid20222023: $924M paid20232024: $1.10B paid2024$1.10B$0$500M$1.00B2020: $646M paid20202021: $641M paid20212022: $685M paid20222023: $924M paid20232024: $1.10B paid2024$1.10B

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

Billers

020K2020: 26K providers20202021: 26K providers20212022: 26K providers20222023: 28K providers20232024: 30K providers202430K020K2020: 26K providers20202021: 26K providers20212022: 26K providers20222023: 28K providers20232024: 30K providers202430K020K2020: 26K providers20202021: 26K providers20212022: 26K providers20222023: 28K providers20232024: 30K providers202430K020K2020: 26K providers20202021: 26K providers20212022: 26K providers20222023: 28K providers20232024: 30K providers202430K

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
202430,091$1,101,657,091+19%14,712,8002241,7641.92
202328,092$924,354,236+35%12,273,1252041,5771.92
202226,291$684,784,757+7%10,623,4661861,4601.55
202125,682$640,927,746-1%9,717,5351761,3661.55
202026,044$646,293,211first year in data9,727,6351721,3511.55

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
Florida1,914$57,491,100852,6542231,574
New York2,049$54,999,520734,6811671,331
California1,732$50,282,346679,1311601,499
Texas1,684$45,418,809701,7522041,357
New Jersey1,251$37,186,266495,0991681,474
Illinois1,477$34,229,061510,8411541,305
Pennsylvania1,582$32,815,678490,6131521,010
Ohio1,299$24,337,296392,5531601,039
Massachusetts876$24,313,868359,5832301,408
Maryland694$24,127,519344,0522561,714
North Carolina728$23,631,156380,4153001,725
Virginia645$22,063,712337,7032461,974
Indiana644$17,950,878301,0982581,554
Michigan884$17,455,200269,7611581,083
Connecticut549$15,815,565238,4362471,407

Not listed: 4 billers with an armed-forces or unknown state code (AP, XX, ZZ); they are in the national totals.

Not listed: 4 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 2020.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ2,255$69,133,879881,687171
Chicago-Naperville-Elgin, IL-IN1,231$31,640,715469,706176
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD845$24,045,274349,644218
Los Angeles-Long Beach-Anaheim, CA784$23,275,597310,392149
Washington-Arlington-Alexandria, DC-VA-MD-WV429$15,131,082211,072219
Boston-Cambridge-Newton, MA-NH541$15,105,488221,847217
Miami-Fort Lauderdale-West Palm Beach, FL532$13,876,273194,861218
Baltimore-Columbia-Towson, MD381$13,104,420187,928258
Dallas-Fort Worth-Arlington, TX411$12,985,087198,522292
Tampa-St. Petersburg-Clearwater, FL366$11,309,283173,145236
Houston-Pasadena-The Woodlands, TX392$10,449,106157,433226
Detroit-Warren-Dearborn, MI496$10,325,102156,986165
Phoenix-Mesa-Chandler, AZ265$8,304,851123,358212
Atlanta-Sandy Springs-Roswell, GA247$8,002,733125,219194
San Francisco-Oakland-Fremont, CA203$7,414,75596,822173

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 2020.

Specialties billing 99309 nationally

Nurse Practitioner accounts for 44% of payment for 99309 nationally in 2020, across 37 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner10,82542%$281,895,58744%4,652,978430
Internal Medicine5,77522%$149,746,08423%2,033,390352
Family Practice3,81915%$79,634,03212%1,124,399294
Physician Assistant1,4725.7%$34,851,6445.4%567,607386
Physical Medicine and Rehabilitation6052.3%$24,494,6163.8%310,876514
Geriatric Medicine6822.6%$15,454,7062.4%214,031314
Psychiatry4821.9%$10,656,6491.6%148,373308
General Practice2290.88%$7,844,0611.2%107,267468
General Surgery1830.70%$5,676,3570.88%74,540407
Hospitalist3721.4%$5,467,0460.85%74,582200
Pulmonary Disease1860.71%$3,844,1480.59%50,689273
Cardiology1400.54%$3,003,0160.46%38,901278
Certified Clinical Nurse Specialist1250.48%$2,667,4260.41%45,029360
Emergency Medicine1290.50%$2,532,3440.39%36,521283
Infectious Disease1180.45%$1,702,1390.26%22,182188

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 2020.

Top billers of 99309 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