CPT code 99421: Online E/M, 5–10 minutes over seven days2026 Medicare rate & RVUs

Medicare pays $15.70 for 99421 nationally in the office and $11.02 in a hospital or facility. Local office rates run $14.43–$20.01.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99421 covers

99421 covers a patient-initiated online evaluation and management service for an established patient. A physician or other qualified health care professional may review the patient’s secure portal message, assess the concern, review relevant records, make a management plan, and communicate recommendations or orders electronically. The service is asynchronous; it is not a scheduled video or telephone visit.

Select this level when the clinician’s cumulative time on the online evaluation and management work is 5–10 minutes during the seven-day period. Count the work across the episode rather than reporting separately for each message. Documentation should show the patient’s concern, the clinician’s assessment and management, the communication, and the total time. When the same problem leads to an in-person or other E/M service during the applicable period, the online work is generally included in that E/M service rather than reported separately.

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.

Where 99421 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99421 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99421 rate is calculated

Each of 99421’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.

Payment rules and modifiers for 99421

99421 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.

99421 compared with similar codes

How to choose

99422Online E/MEstablished patient, 11–20 minutes

Both describe established-patient online E/M over seven days. Choose 99421 for 5–10 cumulative minutes and 99422 for 11–20 minutes.

99423Online E/M21 or more minutes

Both describe established-patient online E/M over seven days. Choose 99421 for 5–10 cumulative minutes and 99423 for 21 minutes or more.

Codes related to 99421

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates