What Medicare pays for 21 common services since 2013, after inflation
Prepared by Benjamin Thomas, MD · Last reviewed November 12, 2026
Medicare sets a national price for every physician service: three relative values (the physician's work, practice expense and malpractice cost) multiplied by a dollar conversion factor set each year. We followed that price for 21 common services from 2013 through 2026, from CMS's own relative value files, and compared it with consumer prices.
From 2013 to 2025, consumer prices rose 38.2%. Measured against them, 20 of the 21 services pay less than they did when the series starts. The conversion factor itself went from $34.02 in 2013 to $32.35 in 2025 and $33.40 in 2026.
The ranking
Procedures lost the most
CMS lowered the work value of common procedures several times. Total knee replacement (27447) went from 23.25 work RVUs in 2013 to 19.6 by 2025; cataract surgery (66984) from 8.52 to 7.35; diagnostic colonoscopy (45378) from 3.69 to 3.26. With a conversion factor lower in 2025 than in 2013, their fees fell even before inflation (−18.9%, −21.8% and −19.6%), and after it each is about 42% to 43% lower.
Office visits lost the least, through one change
In 2021 CMS revalued office visits: the work value of a level 4 established-patient visit (99214) went from 1.5 to 1.92, and of a level 3 visit (99213) from 0.97 to 1.3. That single change is nearly all the gain these codes show, and they still trail prices by 11% (99213) and 15% (99214).
Hospital medicine sits in between
Follow-up hospital visits were revalued for 2023: 99232 from 1.39 to 1.59 work RVUs and 99233 from 2 to 2.4. The high-level initial hospital visit (99223) went the other way, from 3.86 to 3.5, and is 39% lower after inflation. Critical care (99291) has kept the same work value, 4.5, since 2013, so its fee moved only with the conversion factor.
2026 widens the gap between office and hospital
The 2026 fee schedule raised the conversion factor to $33.40 and changed how practice expense is assigned: it rose for services billed in an office and fell for services billed in a facility. Despite the higher conversion factor, the fee for 99232 went from $76.34 in 2025 to $70.48 in 2026, while 99214 went from $125.18 to $135.61. Measured against October 2026 prices, 99214 stays 12% below its 2013 value, 99232 moves to 31% below, and cataract surgery to 52% below.
The services that kept closest
The services nearest to inflation are ones CMS chose to raise. Psychotherapy (90837) gained work value in four steps, from 2.83 to 3.78, and is 5.4% below. Chronic care management (99490), payable from 2015, went from 0.61 to 1 work RVUs and is the one service ahead of prices (+3.8% since 2015).
Each service
Office and outpatient
99204Office visit, new patient, level 4
The 2021 revaluation raised its work RVU only from 2.43 to 2.60.
99203Office visit, new patient, level 3
The 2021 revaluation raised its work RVU from 1.42 to 1.60, a smaller step than the established-patient visits took.
G0439Annual wellness visit, subsequent
Valued with the office visits: work RVU 1.50 to 1.92 in 2021.
99214Office visit, established patient, level 4
The 2021 office visit revaluation raised its work RVU from 1.50 to 1.92.
99213Office visit, established patient, level 3
The 2021 office visit revaluation raised its work RVU from 0.97 to 1.30.
99215Office visit, established patient, level 5
The 2021 office visit revaluation raised its work RVU from 2.11 to 2.80.
90837Psychotherapy, 60 minutes
Work RVU raised in four steps, from 2.83 to 3.78 (2014, 2021, 2024, 2026).
99490Chronic care management, first 20 minutes
Payable from 2015 at 0.61 work RVU; raised to 1.00 in 2022.
Hospital
99223Initial hospital visit, high level
The 2023 hospital visit revaluation lowered its work RVU from 3.86 to 3.50; 2026 lowered facility practice expense.
99239Hospital discharge, over 30 minutes
The 2023 revaluation raised its work RVU from 1.90 to 2.15.
99232Follow-up hospital visit, mid level
The 2023 revaluation raised its work RVU from 1.39 to 1.59; 2026 lowered facility practice expense from 0.63 to 0.40.
99238Hospital discharge, 30 minutes or less
The 2023 revaluation raised its work RVU from 1.28 to 1.50.
99233Follow-up hospital visit, high level
The 2023 revaluation raised its work RVU from 2.00 to 2.40.
99231Follow-up hospital visit, low level
The 2023 revaluation raised its work RVU from 0.76 to 1.00.
Emergency and critical care
99291Critical care, first hour
Its work RVU has stayed at 4.50 since 2013; the conversion factor fell.
99285Emergency department visit, level 5
Work RVU raised slightly, from 3.80 to 4.00 (2021).
99284Emergency department visit, level 4
Work RVU raised slightly, from 2.56 to 2.74 (2020 and 2021).
Procedures
66984Cataract surgery
Work RVU lowered from 8.52 to 7.35 in 2020 and to 7.17 in 2026; practice expense from 9.74 to 6.14.
45378Diagnostic colonoscopy
Work RVU lowered from 3.69 to 3.26 (2016 and 2017) and to 3.18 (2026).
27447Total knee replacement
Work RVU lowered from 23.25 to 20.72 (2014), 19.60 (2021) and 19.11 (2026).
93306Echocardiogram, complete
Work RVU 1.30 to 1.50 in 2018, back to 1.42 in 2026; global (office) rate.
The numbers
| Code | Service | First year | Fee then | Fee 2025 | Fee 2026 | First fee at 2025 prices | After inflation to 2025 | After inflation to 2026 |
|---|---|---|---|---|---|---|---|---|
| 66984 | Cataract surgery | 2013 | $666.85 | $521.75 | $462.60 | $921.58 | −43.4% | −52.1% |
| 45378 | Diagnostic colonoscopy | 2013 | $220.47 | $177.26 | $164.67 | $304.69 | −41.8% | −48.4% |
| 27447 | Total knee replacement | 2013 | $1,551.11 | $1,257.63 | $1,159.35 | $2,143.61 | −41.3% | −48.4% |
| 99223 | Initial hospital visit, high level | 2013 | $197.67 | $167.23 | $156.32 | $273.18 | −38.8% | −45.4% |
| 99291 | Critical care, first hour | 2013 | $217.75 | $205.72 | $199.07 | $300.93 | −31.6% | −36.9% |
| 93306 | Echocardiogram, complete | 2013 | $189.51 | $187.93 | $196.73 | $261.90 | −28.2% | −28.3% |
| 99204 | Office visit, new patient, level 4 | 2013 | $164.67 | $163.35 | $177.36 | $227.57 | −28.2% | −25.7% |
| 99285 | Emergency department visit, level 5 | 2013 | $167.73 | $168.85 | $171.35 | $231.80 | −27.2% | −29.5% |
| 99203 | Office visit, new patient, level 3 | 2013 | $107.85 | $109.01 | $117.57 | $149.05 | −26.9% | −24.8% |
| 99284 | Emergency department visit, level 4 | 2013 | $114.32 | $116.45 | $118.24 | $157.99 | −26.3% | −28.6% |
| 99239 | Hospital discharge, over 30 minutes | 2013 | $104.45 | $110.63 | $106.55 | $144.35 | −23.4% | −29.6% |
| 99232 | Follow-up hospital visit, mid level | 2013 | $70.09 | $76.34 | $70.48 | $96.86 | −21.2% | −30.6% |
| 99238 | Hospital discharge, 30 minutes or less | 2013 | $70.77 | $78.28 | $74.82 | $97.80 | −20.0% | −27.0% |
| 99233 | Follow-up hospital visit, high level | 2013 | $101.05 | $113.86 | $106.88 | $139.65 | −18.5% | −27.0% |
| G0439 | Annual wellness visit, subsequent | 2013 | $111.94 | $126.47 | $137.61 | $154.70 | −18.2% | −15.1% |
| 99214 | Office visit, established patient, level 4 | 2013 | $106.49 | $125.18 | $135.61 | $147.17 | −14.9% | −12.1% |
| 99213 | Office visit, established patient, level 3 | 2013 | $72.47 | $88.95 | $95.19 | $100.15 | −11.2% | −9.3% |
| 99215 | Office visit, established patient, level 5 | 2013 | $142.90 | $175.64 | $192.39 | $197.49 | −11.1% | −7.1% |
| 99231 | Follow-up hospital visit, low level | 2013 | $38.11 | $47.23 | $44.09 | $52.67 | −10.3% | −20.1% |
| 90837 | Psychotherapy, 60 minutes | 2013 | $118.06 | $154.29 | $167.00 | $163.16 | −5.4% | −2.4% |
| 99490 | Chronic care management, first 20 minutes | 2015 | $42.91 | $60.49 | $66.13 | $58.29 | +3.8% | +8.2% |
What these numbers are, and are not
- Medicare's national fee schedule amounts with no geographic adjustment, from the January relative value file of each year (RVU13A through RVU25A) and RVU26D for 2026. Hospital, emergency and surgical services use the facility rate; office services and the echocardiogram (global) the office rate.
- The full fee, before the patient's 20% share and before sequestration. Not take-home pay, and not what other insurers pay.
- For 2013 the January file carried a conversion factor of $25.0008, a scheduled cut that Congress cancelled on January 2, 2013; the rate paid, $34.02, is used. Changes made partway through a year (2015, 2024) are not shown.
- Inflation is the Bureau of Labor Statistics consumer price index (CPI-U, U.S. city average, all items): annual averages, and for 2026 the latest month published. Consumer prices are not the cost of running a practice, which CMS tracks separately in the Medicare Economic Index.
- Code numbers are used for reference; the service names are plain descriptions, not CPT descriptors. CPT is a registered trademark of the American Medical Association. The formulas are on the methodology page.
Sources
- CMS, PFS Relative Value Files (PPRRVU)
- CMS, Physician Fee Schedule federal regulation notices (annual proposed and final rules)
- U.S. Bureau of Labor Statistics, Consumer Price Index for All Urban Consumers (CPI-U), series CUUR0000SA0
General information about public Medicare data and payment rules, not legal, tax or financial advice. Related: Methodology · Sample report