HCPCS 99316

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

Evaluation and management Work RVU per service 2.50 (2023 fee schedule)

6,630
96th percentile among 6,405 codes billed · 2023
$30M
94th percentile among 6,405 codes billed · 2023
326K
92nd percentile among 6,405 codes billed · 2023
32
61st percentile among 6,405 codes billed · 2023
146
62nd percentile among 6,405 codes billed · 2023
+27.9%
Medicare payment on the code vs 2022; billers +2.8% · 2023

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 York624$3,813,57636,21136173
California384$2,624,74524,80639196
Florida370$1,980,17621,10836176
Massachusetts276$1,583,87317,03341187
New Jersey312$1,571,10815,32735126
Pennsylvania392$1,433,74215,57525126
Virginia272$1,373,06915,22439148
Maryland227$1,329,95713,91743171
Illinois248$1,098,81311,67930133
North Carolina266$1,048,76012,03832127
Michigan243$989,83611,12832114
Ohio246$833,4109,50428101
Texas235$798,7578,69225106
Connecticut168$679,2767,46234103
Tennessee164$661,9168,04833153

Not listed: 1 billers with an armed-forces or unknown state code (AP); 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 2023.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ558$3,776,45734,21838
Boston-Cambridge-Newton, MA-NH182$1,084,45611,61341
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD231$1,050,94111,04831
Chicago-Naperville-Elgin, IL-IN175$855,4139,00637
Baltimore-Columbia-Towson, MD127$810,5198,58346
Washington-Arlington-Alexandria, DC-VA-MD-WV137$773,5537,83943
Los Angeles-Long Beach-Anaheim, CA105$734,1266,91036
Detroit-Warren-Dearborn, MI122$473,7855,17830
San Francisco-Oakland-Fremont, CA73$440,7163,94034
Seattle-Tacoma-Bellevue, WA74$399,5844,39743
Minneapolis-St. Paul-Bloomington, MN-WI113$397,5834,64629
Miami-Fort Lauderdale-West Palm Beach, FL73$394,9844,05233
Tampa-St. Petersburg-Clearwater, FL75$385,2084,12341
Phoenix-Mesa-Chandler, AZ67$380,4034,06139
Virginia Beach-Chesapeake-Norfolk, VA-NC66$367,5234,23947

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 96 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2023.

Specialties billing 99316 nationally

Nurse Practitioner accounts for 52% of payment for 99316 nationally in 2023, across 10 specialties on claims.

observed calculated calculated calculated calculated calculated
Nurse Practitioner3,67955%$15,727,34652%181,92449
Internal Medicine1,32520%$7,513,58425%70,53353
Family Practice5758.7%$2,545,1528.4%24,79843
Physician Assistant5267.9%$2,248,7607.4%26,04650
Geriatric Medicine1842.8%$932,1473.1%8,59647
Hospitalist1922.9%$771,1942.5%7,32138
General Practice330.50%$174,3630.57%1,59348
Physical Medicine and Rehabilitation210.32%$143,4080.47%1,32963
Emergency Medicine300.45%$97,7770.32%97533
Certified Clinical Nurse Specialist150.23%$70,5020.23%82255

Not listed: 20 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 2023.

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