What does Cigna pay for CPT 99213 in Wisconsin?

Based on Cigna's published Transparency in Coverage file, the median in-network office rate for CPT 99213 in Wisconsin is $85.64, with most rates falling between $36.16 and $132.46. This is drawn from 66 negotiated rates in the file.

How does that compare to Medicare?

Medicare's non-facility (office) allowed amount for CPT 99213 in Wisconsin is about $91.06. Cigna's median of $85.64 is roughly 94 percent of the Medicare rate.

If Cigna pays you below $85.64 for CPT 99213 in Wisconsin, you are being paid less than the middle of what they pay across the market. That does not automatically mean the contract is bad, but it usually means there is room to ask for more. A fee-schedule review will tell you where you stand.

What Cigna Pays for CPT 99213 in Wisconsin

Established patient office visit, low complexity. Office place of service. Straight from Cigna's own Transparency in Coverage file.

Median $85.64

94% of Medicare

66 rates

Office setting

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4.9/5 Rating

300+ Practices

Median rate

$85.64

across 66 published rates

Typical range

$36.16

25th percentile

$132.46

75th percentile

vs Medicare

94%

Medicare pays $91.06

What each payer pays for 99213 in Wisconsin

Same code, same office setting, same state. Every figure comes from that payer’s own Transparency in Coverage file. The highest published median here is 1.17x the lowest.

UnitedHealthcare

Choice Plus national network (August 2026 TiC file)

$99.87

110% of Medicare

$79.46 to $130.57 middle range · 431 ratesDetail

Cignathis page

Open Access Plus national network (August 2026 TiC file)

$85.64

94% of Medicare

$36.16 to $132.46 middle range · 66 rates

Medicare

Non-facility allowed amount, Wisconsin

$91.06

These payers do not structure their files identically, so read the methodology before treating any single figure as your rate.

When a Wisconsin practice bills Cigna for CPT 99213, the file shows a median negotiated office rate of $85.64. Half of the rates in the file sit above that number and half below, and most cluster between $36.16 and $132.46. Against the Medicare office rate of $91.06 for the same code and state, the median lands at about 94 percent of Medicare.

The spread matters as much as the median. A wide gap between the 25th and 75th percentile means Cigna pays very differently for the same work depending on who negotiated the contract. If you are near the bottom of that range, the payer is already paying other Wisconsin practices more for identical claims, which is exactly the argument that moves a fee-schedule negotiation.

Rate Reality Check

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What Cigna pays you for 99213 (per claim)

$36.16 (25th)$85.64 (median)$132.46 (75th)

Based on 66 published rates. Medicare pays about $91.06 here.

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CPT 99213 coding and billing All Cigna rates How we build these numbers Fee-schedule negotiation

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