MEDICARE FEE CALCULATOR

What does Medicare pay for this code?

Pick a CPT code and a state. See the 2026 Physician Fee Schedule payment for both facility and non-facility settings, with the national average for comparison.

CPT 99213
Established patient office visit, low MDM or 20-29 minutes
Non-facility
Private office, urgent care, ambulatory
$95.19
national rate (no GPCI adjustment)
Facility
Hospital, ASC, nursing home
$57.45
national rate (no GPCI adjustment)
How CMS calculates this
Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor

Each RVU component has its own locality-specific Geographic Practice Cost Index (GPCI). The locality-adjusted RVU sum is then multiplied by the national Conversion Factor to produce the payment amount.

Work RVU
1.30
PE RVU
1.46
MP RVU
0.09
CF
$33.4009
See all 53 state payments
StateNon-facilityFacility
AK$118.72$78.53
DC$106.56$62.10
CA$104.31$59.65
NY$103.97$61.86
NJ$103.82$61.32
WA$102.75$59.73
MA$101.98$59.58
HI$100.61$57.69
CT$100.45$59.80
FL$98.20$60.33
CO$98.18$58.02
MD$98.06$58.72
OR$97.31$57.55
RI$97.30$58.31
NH$96.82$57.53
IL$96.44$59.97
PR$95.68$57.53
VI$95.68$57.53
MT$95.19$57.44
PA$94.79$57.82
NV$94.74$56.96
DE$94.52$57.23
MN$94.49$55.65
TX$94.46$57.30
WY$94.41$56.67
GA$93.60$57.60
VA$93.48$56.38
MI$93.44$58.01
ND$93.41$55.66
AZ$93.25$56.67
VT$93.22$55.85
SD$93.20$55.45
UT$91.96$56.48
ME$91.90$55.84
NM$91.75$57.14
MO$91.13$56.50
LA$91.09$56.64
WI$91.06$54.91
SC$91.04$56.16
OH$90.97$56.51
NC$90.84$55.63
WV$90.10$57.30
IN$90.09$55.10
ID$89.71$54.98
NE$89.57$54.73
KY$89.52$55.97
TN$89.36$55.05
OK$89.30$55.60
IA$89.23$54.70
KS$89.02$54.90
AL$87.79$54.77
MS$87.63$55.13
AR$86.86$54.44
Need more depth?
WHY PAYMENT VARIES

Why does Medicare pay different amounts in different places?

Geographic Practice Cost Index

Medicare adjusts each RVU component by GPCI: physician work, practice expense, and malpractice. High cost-of-living areas like California and New York pay more; rural states pay less.

Facility vs non-facility

When the service is performed in a facility (hospital, ASC), part of the practice expense is paid to the facility instead of the physician, so the physician fee is lower.

Conversion factor

The CMS Conversion Factor is set annually and applies nationally. The 2026 factor multiplies your locality-adjusted RVUs to produce the dollar payment.

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