CPT code 99213: Office visit, established patient, low complexity2026 Medicare rate & RVUs in California
An established patient office or outpatient visit reported for low medical decision making or at least 20 minutes of billing practitioner time.
Medicare pays $99.22–$120.13 for 99213 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 99213 covers
This visit covers an established patient seen in an office, clinic, or other outpatient setting. Examples include follow-up for one stable chronic condition, such as controlled hypertension, or assessment of an uncomplicated urinary tract infection or sinusitis. Physicians, nurse practitioners, and physician assistants report it across primary care and specialty practices. The encounter may include a medically appropriate history and examination, but those activities do not set the visit level.
Select the level by medical decision making or total billing practitioner time on the encounter date. Low decision making requires two of three elements at the low level: problems addressed, data reviewed or analyzed, and management risk. Limited data may be met by an independent historian or the required combination of distinct record reviews, test reviews, and test orders; an over-the-counter treatment recommendation may indicate low risk. Alternatively, at least 20 minutes supports 99213, including qualifying review, documentation, and care coordination, but excluding clinical staff time. Document the problems and decision-making elements, or the practitioner's total time. A patient is established after professional services from the practitioner or a same-specialty, same-subspecialty group member within three years. Medicare assigns lower practice expense RVUs in a facility than in an office.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Billing guides for 99213: G2211 add-on code
Where 99213 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$99.22 to $120.13
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $99.52 | $58.16 |
| Chico, CA | $99.22 | $57.85 |
| El Centro, CA | $99.23 | $57.87 |
| Fresno, CA | $99.22 | $57.85 |
| Hanford, CA | $99.22 | $57.85 |
| Los Angeles, CA | $104.89 | $60.24 |
| Madera, CA | $99.22 | $57.85 |
| Marin County, CA | $117.69 | $64.47 |
| Merced, CA | $99.22 | $57.85 |
| Modesto, CA | $99.22 | $57.85 |
| Napa, CA | $111.96 | $62.21 |
| Oxnard, CA | $104.15 | $59.54 |
| Redding, CA | $99.22 | $57.85 |
| Rest of California | $99.22 | $57.85 |
| Riverside, CA | $100.21 | $58.85 |
| Sacramento, CA | $103.31 | $59.41 |
| Salinas, CA | $102.90 | $59.15 |
| San Benito County, CA | $120.13 | $65.70 |
| San Diego, CA | $104.68 | $59.54 |
| San Francisco, CA | $117.58 | $64.37 |
| San Luis Obispo, CA | $101.31 | $58.32 |
| Santa Clara County, CA | $119.71 | $65.29 |
| Santa Cruz, CA | $105.19 | $59.34 |
| Santa Maria, CA | $103.11 | $59.10 |
| Santa Rosa, CA | $106.22 | $59.87 |
| Stockton, CA | $99.22 | $57.85 |
| Vallejo, CA | $111.81 | $62.06 |
| Visalia, CA | $99.22 | $57.85 |
| Yuba City, CA | $99.22 | $57.85 |
How the 99213 rate is calculated
Each of 99213’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99213
RVUs × geographic indexes × conversion factor
Work1.30
1.30 RVUs× 1.000 GPCI
Practice expense1.46
1.46 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
2.8500
Conversion factor
$33.4009
Medicare rate
$95.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99213
99213 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.
Place of service · 99213
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$95.19
- Non-facility (office)
- $95.19
- Facility
- $57.45
Higher because the practice carries its own overhead.
99213 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99214Office visitEstablished patient, moderate complexity
- 99214 requires moderate decision making in two of three elements or at least 30 minutes when selected by time. Prescription drug management may establish moderate risk, but risk alone does not establish moderate decision making.
- 99212Office visitEstablished patient, straightforward
- 99212 requires straightforward decision making or at least 10 minutes when selected by time. Choose 99213 for low decision making or at least 20 minutes.
- 99203New patient visitLow MDM or 30 minutes
- 99203 is for a new patient and requires at least 30 minutes when selected by time, versus 20 minutes for 99213. Check prior professional services from the practitioner or a same-specialty, same-subspecialty group member within three years.
- 99243Office consultationLow MDM, 30 minutes
- 99243 represents a requested office consultation when the payer recognizes consultation codes. Medicare does not recognize those codes; report the appropriate office visit level, such as 99213 when its established-patient criteria are met.
99213 billing questions
What separates 99213 from 99214 when billing by decision making?
99214 requires moderate decision making in two of three elements. Prescription drug management can indicate moderate risk, but another decision-making element must also reach moderate.
How much time is needed to bill 99213 based on time?
At least 20 minutes of billing practitioner time on the encounter date supports 99213; 30 minutes supports 99214 when selecting by time. Count qualifying face-to-face and non-face-to-face work, not clinical staff time or time spent on separately reported services.
Can 99213 be billed on the same day as a minor procedure?
Yes, if a significant, separately identifiable evaluation beyond the usual pre-procedure assessment is documented; append modifier 25 to 99213. The decision to perform the minor procedure alone does not justify a separate visit.
Can G2211 be added to 99213 for Medicare patients?
Yes, when the practitioner provides ongoing care as the continuing focal point for the patient's care or ongoing care for a single serious or complex condition. G2211 reflects visit complexity arising from that continuing relationship.
Are history and examination required to select 99213?
No. Perform and document them as medically appropriate; the level is selected by medical decision making or total billing practitioner time.
99213 is in these specialty bundles: Primary care
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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