HCPCS 99316

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

Evaluation and management Work RVU per service 2.50 (2024 fee schedule)

6,848
96th percentile among 6,471 codes billed · 2024
$30M
94th percentile among 6,471 codes billed · 2024
333K
92nd percentile among 6,471 codes billed · 2024
32
60th percentile among 6,471 codes billed · 2024
141
61st percentile among 6,471 codes billed · 2024
+0.0%
Medicare payment on the code vs 2023; billers +3.3% · 2024

Trend

Medicare payment on the code

$0$20M2020: $23M paid20202021: $24M paid20212022: $24M paid20222023: $30M paid20232024: $30M paid2024$30M$0$20M2020: $23M paid20202021: $24M paid20212022: $24M paid20222023: $30M paid20232024: $30M paid2024$30M$0$20M2020: $23M paid20202021: $24M paid20212022: $24M paid20222023: $30M paid20232024: $30M paid2024$30M$0$20M2020: $23M paid20202021: $24M paid20212022: $24M paid20222023: $30M paid20232024: $30M paid2024$30M

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

Billers

05,0002020: 6,423 providers20202021: 6,367 providers20212022: 6,448 providers20222023: 6,630 providers20232024: 6,848 providers20246,84805,0002020: 6,423 providers20202021: 6,367 providers20212022: 6,448 providers20222023: 6,630 providers20232024: 6,848 providers20246,84805,0002020: 6,423 providers20202021: 6,367 providers20212022: 6,448 providers20222023: 6,630 providers20232024: 6,848 providers20246,84805,0002020: 6,423 providers20202021: 6,367 providers20212022: 6,448 providers20222023: 6,630 providers20232024: 6,848 providers20246,848

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
20246,848$30,484,399+0%333,301321412.50
20236,630$30,478,605+28%326,303321462.50
20226,448$23,835,201-1%319,555321471.90
20216,367$24,055,250+5%312,496331421.90
20206,423$22,840,735first year in data295,216311311.90

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 York587$3,617,69235,44936212
California408$2,771,14227,05442182
Florida403$2,110,54922,96234185
New Jersey311$1,668,74416,66236144
Massachusetts283$1,537,42416,81043169
Pennsylvania405$1,496,87016,58630116
Virginia290$1,375,56115,66941150
Maryland246$1,295,68013,76840145
Illinois263$1,124,58912,19331127
North Carolina272$1,066,68412,64131124
Michigan226$911,84310,36035117
Ohio250$811,2429,3992894
Texas233$729,3438,0642487
Tennessee169$708,0828,71136158
Connecticut171$667,9507,4133594

Not listed: 1 billers with an armed-forces or unknown state code (AP); 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 2024.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ553$3,773,23535,51738
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD240$1,128,30012,06634
Boston-Cambridge-Newton, MA-NH189$1,075,33811,74938
Chicago-Naperville-Elgin, IL-IN179$866,3199,31536
Baltimore-Columbia-Towson, MD140$791,6038,41944
Washington-Arlington-Alexandria, DC-VA-MD-WV156$789,5078,38240
Los Angeles-Long Beach-Anaheim, CA115$773,8307,54036
San Francisco-Oakland-Fremont, CA75$417,3303,90937
Detroit-Warren-Dearborn, MI106$417,3014,63331
Phoenix-Mesa-Chandler, AZ79$413,6264,51134
Miami-Fort Lauderdale-West Palm Beach, FL84$412,0014,33932
Tampa-St. Petersburg-Clearwater, FL82$410,4404,48230
Minneapolis-St. Paul-Bloomington, MN-WI114$389,9544,70930
Seattle-Tacoma-Bellevue, WA79$366,1334,08335
Allentown-Bethlehem-Easton, PA-NJ65$342,1993,83254

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 93 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 99316 nationally

Nurse Practitioner accounts for 53% of payment for 99316 nationally in 2024, across 10 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner3,93257%$16,193,00653%190,38948
Internal Medicine1,31619%$7,410,58724%71,36654
Family Practice5788.4%$2,445,4018.0%24,20342
Physician Assistant5247.7%$2,154,6957.1%25,37048
Geriatric Medicine1742.5%$859,1402.8%8,12547
Hospitalist1882.7%$803,8752.6%7,74841
General Practice280.41%$151,3760.50%1,47653
Physical Medicine and Rehabilitation200.29%$106,4370.35%1,03952
Emergency Medicine240.35%$91,6080.30%88937
Certified Clinical Nurse Specialist140.20%$49,5300.16%59943

Not listed: 22 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 99316 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