HCPCS 99426
Evaluation and management service (ClaimLight category; the code descriptor is not shown)
Evaluation and management Work RVU per service 1.00 (2022 fee schedule)
Trend
Medicare payment on the code
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2022–2024.
Billers
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2022–2024.
| observed | calculated | calculated | calculated | calculated | calculated | reported | |
|---|---|---|---|---|---|---|---|
| 2024 | 1,927 | $21,186,853 | +121% | 453,609 | 113 | 754 | 1.00 |
| 2023 | 1,130 | $9,584,874 | +218% | 205,256 | 73 | 583 | 1.00 |
| 2022 | 421 | $3,010,869 | not in the 2021 file | 63,763 | 58 | 552 | 1.00 |
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2022–2024.
By state
| observed | calculated | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|---|
| Texas | 68 | $578,560 | 12,438 | 113 | 529 | |
| South Carolina | 12 | $465,616 | 9,876 | 602 | 1,729 | |
| Mississippi | 22 | $317,810 | 7,211 | 170 | 933 | |
| Louisiana | 18 | $214,673 | 4,664 | 185 | 642 | |
| New York | 33 | $170,030 | 3,450 | 53 | 456 | |
| California | 37 | $148,991 | 2,902 | 49 | 293 | |
| Tennessee | 27 | $99,125 | 2,134 | 43 | 212 | |
| Illinois | 14 | $93,810 | 1,987 | 63 | 501 | |
| Arkansas | 17 | $67,750 | 1,497 | 72 | 160 | |
| North Carolina | 16 | $65,825 | 1,395 | 41 | 391 | |
| Colorado | 12 | $41,728 | 839 | 59 | 149 | |
| Oregon | 11 | $11,940 | 301 | 26 | 45 |
Not listed: 1 billers with an armed-forces or unknown state code (ZZ); they are in the national totals.
Not listed: 28 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 | |
|---|---|---|---|---|---|
| Amarillo, TX | 11 | $191,033 | 4,242 | 373 | |
| Austin-Round Rock-San Marcos, TX | 26 | $121,656 | 2,441 | 88 | |
| New York-Newark-Jersey City, NY-NJ | 25 | $117,552 | 2,274 | 44 | |
| Chicago-Naperville-Elgin, IL-IN | 13 | $92,571 | 1,962 | 72 | |
| Jackson, MS | 13 | $87,078 | 1,871 | 121 | |
| Albany-Schenectady-Troy, NY | 11 | $77,018 | 1,654 | 85 | |
| Little Rock-North Little Rock-Conway, AR | 12 | $53,187 | 1,176 | 108 | |
| Nashville-Davidson--Murfreesboro--Franklin, TN | 15 | $39,645 | 854 | 43 | |
| Asheville, NC | 12 | $19,737 | 413 | 36 | |
| Grants Pass, OR | 11 | $11,940 | 301 | 26 |
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 10 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 99426 nationally
Cardiology accounts for 34% of payment for 99426 nationally in 2022, across 11 specialties on claims.
| observed | calculated | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|---|
| Cardiology | 54 | 13% | $1,033,019 | 34% | 21,938 | 406 |
| Interventional Cardiology | 21 | 5.0% | $319,808 | 11% | 7,295 | 347 |
| Urology | 66 | 16% | $270,615 | 9.0% | 5,525 | 84 |
| Ophthalmology | 26 | 6.2% | $255,031 | 8.5% | 5,305 | 204 |
| Hematology-Oncology | 75 | 18% | $160,983 | 5.3% | 3,296 | 44 |
| Pulmonary Disease | 12 | 2.9% | $113,107 | 3.8% | 2,328 | 194 |
| Nurse Practitioner | 13 | 3.1% | $102,004 | 3.4% | 2,401 | 185 |
| Internal Medicine | 22 | 5.2% | $79,559 | 2.6% | 1,685 | 77 |
| Nephrology | 16 | 3.8% | $55,313 | 1.8% | 1,088 | 68 |
| Medical Oncology | 20 | 4.8% | $48,687 | 1.6% | 995 | 50 |
| Physical Medicine and Rehabilitation | 13 | 3.1% | $38,596 | 1.3% | 748 | 58 |
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 2022.
Top billers of 99426 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