CPT Code 99213
Office visit for an established patient, low complexity, 20 minutes
Source: CMS 2026 Physician Fee Schedule. Maintained by the D3rx Clinical Billing Team.
2026 Medicare national rate
Office (non-facility)
$95.19
Performed in a physician office
Facility
$57.45
Hospital / ASC setting
Total RVUs (office)
2.85
1.72 facility
Conversion factor
$33.4009
2026 PFS
Medicare payment = total RVUs × GPCI (locality adjustment) × conversion factor. At the national level (GPCI = 1.0), 2.85 × 33.4009 = $95.19 (office). Facility rates are lower because the facility separately bills its overhead.
RVU breakdown
Work RVU
1.30
Office PE RVU
1.46
Facility PE RVU
0.33
Malpractice RVU
0.09
PC/TC: Physician service — not subject to a professional/technical split.
Billing notes
- Medicare pays $37.74 more for 99213 in an office ($95.19) than in a facility ($57.45). The office (non-facility) rate carries the practice-expense overhead a hospital or ASC bills separately, so the place-of-service code you submit directly changes the allowable.
- The national allowable is built from 2.85 total office RVUs × the $33.4009 conversion factor; multiply by your locality GPCIs (above) to reconcile a specific remittance.
Established-patient E/M levels compared
| Code | Office rate | Total RVUs |
|---|---|---|
| 99211 | $24.38 | 0.73 |
| 99212 | $59.45 | 1.78 |
| 99213 · this code | $95.19 | 2.85 |
| 99214 | $135.61 | 4.06 |
| 99215 | $192.39 | 5.76 |
Documenting up from 99213 to 99214 adds $40.42 per visit at national rates — which is why E/M leveling is the highest-yield place to get coding right.
2026 rate by locality
| Locality | Office | Facility |
|---|---|---|
| National (GPCI 1.0) | $95.19 | $57.45 |
| Manhattan, NY | $107.63 | $63.78 |
| Los Angeles, CA | $104.89 | $60.24 |
| Houston, TX | $96.33 | $58.85 |
| Chicago, IL | $99.63 | $61.70 |
| Miami, FL | $101.79 | $62.50 |
| Atlanta, GA | $96.71 | $58.36 |
Computed from CMS 2026 GPCIs: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × $33.4009. Your MAC's locality may differ.
Related Evaluation & Management codes
Related guides
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Medical billing disclaimer
Rates shown are 2026 Medicare Physician Fee Schedule amounts and are for educational reference. Commercial payers, locality, and plan rules vary. Always verify current rates and coverage with the payer before billing. D3rx is not responsible for claim outcomes.