HCPCS 99309

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

Evaluation and management Work RVU per service 1.55 (2022 fee schedule)

26,291
99th percentile among 6,326 codes billed · 2022
$685M
100th percentile among 6,326 codes billed · 2022
10.6M
99th percentile among 6,326 codes billed · 2022
186
91st percentile among 6,326 codes billed · 2022
1,460
91st percentile among 6,326 codes billed · 2022
+6.8%
Medicare payment on the code vs 2021; billers +2.4% · 2022

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
Florida1,957$65,152,029995,2992411,909
New York2,014$64,245,766874,7911981,635
California1,655$58,830,649816,9171932,013
Texas1,735$45,707,498728,9792161,414
New Jersey1,246$37,947,565528,7631981,596
Pennsylvania1,553$34,398,546529,8861641,192
Illinois1,369$32,485,875492,5901581,275
Maryland739$29,576,845436,0802922,022
Massachusetts779$24,395,129375,0052921,550
Ohio1,339$23,597,187397,7811641,021
Virginia733$23,444,722374,0072361,728
North Carolina829$21,478,438361,6472631,338
Indiana702$20,451,010354,5612651,760
Michigan854$15,489,587249,381165993
Tennessee618$14,521,962253,6412311,326

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

Not listed: 3 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 2022.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ2,259$77,682,0361,024,658202
Chicago-Naperville-Elgin, IL-IN1,144$32,161,302487,980194
Los Angeles-Long Beach-Anaheim, CA754$29,339,148402,336196
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD875$25,484,476380,518217
Washington-Arlington-Alexandria, DC-VA-MD-WV476$18,154,136260,608273
Miami-Fort Lauderdale-West Palm Beach, FL557$16,701,564241,197197
Boston-Cambridge-Newton, MA-NH493$15,899,408242,719292
Baltimore-Columbia-Towson, MD405$15,787,116233,990282
Tampa-St. Petersburg-Clearwater, FL378$15,065,281235,439262
Dallas-Fort Worth-Arlington, TX449$13,781,344216,473289
Houston-Pasadena-The Woodlands, TX382$10,369,849160,804234
Phoenix-Mesa-Chandler, AZ299$9,335,616147,127223
Detroit-Warren-Dearborn, MI468$8,856,834139,362183
Atlanta-Sandy Springs-Roswell, GA272$8,689,057143,996267
Denver-Aurora-Centennial, CO263$7,833,887123,757268

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 2022.

Specialties billing 99309 nationally

Nurse Practitioner accounts for 46% of payment for 99309 nationally in 2022, across 35 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner12,33747%$315,290,87146%5,340,591433
Internal Medicine5,06619%$145,295,08921%2,017,143398
Family Practice3,34813%$74,076,66611%1,074,640321
Physician Assistant1,6916.4%$42,413,8206.2%707,934419
Physical Medicine and Rehabilitation6162.3%$29,608,4984.3%392,199637
Geriatric Medicine6182.4%$12,173,7881.8%173,184280
Psychiatry4031.5%$9,115,4401.3%127,618317
Hospitalist3891.5%$8,414,2501.2%118,421304
General Practice2130.81%$8,389,2431.2%116,123545
General Surgery1920.73%$7,354,9651.1%98,915515
Emergency Medicine1340.51%$3,889,8620.57%57,280427
Pulmonary Disease1560.59%$3,236,3510.47%42,886275
Cardiology1110.42%$2,453,9080.36%31,759286
Certified Clinical Nurse Specialist950.36%$2,306,0530.34%40,727429
Nephrology1090.41%$1,929,0660.28%26,726245

Not listed: 28 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 2022.

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