HCPCS 99316

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

Evaluation and management Work RVU per service 1.90 (2022 fee schedule)

6,448
95th percentile among 6,326 codes billed · 2022
$24M
93rd percentile among 6,326 codes billed · 2022
320K
91st percentile among 6,326 codes billed · 2022
32
62nd percentile among 6,326 codes billed · 2022
147
64th percentile among 6,326 codes billed · 2022
-0.9%
Medicare payment on the code vs 2021; billers +1.3% · 2022

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 York615$2,892,77034,29437153
California360$1,943,77222,93635196
Florida349$1,491,51419,90635176
Massachusetts287$1,301,53417,47938170
New Jersey287$1,214,55214,74036154
Pennsylvania353$1,161,45415,63828140
Maryland228$1,142,20514,89452173
Virginia256$1,066,85214,80938159
Illinois240$915,68912,23735146
Michigan270$844,11711,81931110
North Carolina250$820,69611,99136123
Ohio271$747,19010,73230100
Texas245$639,1418,76827101
Connecticut171$596,8668,13234122
Arizona108$509,2526,84740189

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-NJ552$2,856,75432,27838
Boston-Cambridge-Newton, MA-NH189$896,35511,97139
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD207$882,99411,55238
Chicago-Naperville-Elgin, IL-IN177$738,3649,75738
Baltimore-Columbia-Towson, MD134$687,9189,07952
Washington-Arlington-Alexandria, DC-VA-MD-WV132$686,5788,66752
Los Angeles-Long Beach-Anaheim, CA96$564,9176,66131
Detroit-Warren-Dearborn, MI145$436,8795,96030
Phoenix-Mesa-Chandler, AZ77$367,4034,95641
Tampa-St. Petersburg-Clearwater, FL87$335,9464,52328
San Francisco-Oakland-Fremont, CA71$307,2053,49627
Minneapolis-St. Paul-Bloomington, MN-WI112$299,2024,39728
Miami-Fort Lauderdale-West Palm Beach, FL65$295,8883,78940
Allentown-Bethlehem-Easton, PA-NJ55$277,8803,78669
Seattle-Tacoma-Bellevue, WA71$277,2843,83234

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 95 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 99316 nationally

Nurse Practitioner accounts for 50% of payment for 99316 nationally in 2022, across 10 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner3,42753%$11,898,11850%173,16451
Internal Medicine1,40222%$6,131,58626%72,17951
Family Practice6239.7%$2,138,8689.0%26,22042
Physician Assistant4837.5%$1,709,1607.2%24,83951
Geriatric Medicine1852.9%$734,9873.1%8,56646
Hospitalist1792.8%$635,7882.7%7,49142
General Practice310.48%$136,5210.57%1,58751
Physical Medicine and Rehabilitation240.37%$84,5470.35%99241
Emergency Medicine220.34%$79,2590.33%98545
Certified Clinical Nurse Specialist150.23%$58,1930.24%85757

Not listed: 19 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 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