CPT code 99422: Online E/M, established patient, 11–20 minutes2026 Medicare rate & RVUs

Medicare pays $30.73 for 99422 nationally in the office and $22.38 in a hospital or facility. Local office rates run $28.29–$39.30.

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

What 99422 covers

This code covers a patient-initiated, asynchronous evaluation and management service handled through a secure online channel, such as a patient portal. A physician or other qualified health professional reviews the patient’s request and relevant record, evaluates the issue, and responds with management advice or orders as appropriate. It is used for established patients whose concern can be addressed without a real-time office, phone, or video visit.

Report the code once for the physician’s or qualified health professional’s cumulative service time of 11–20 minutes during the seven-day period. Time may include reviewing the request and record, assessment and management, and communicating the response; clinical staff time is not the provider time counted for this service. Keep the patient’s request, clinical assessment, response, dates, and time accounting in the record. The service is not separately reported when it arises from a related E/M service in the preceding seven days or leads to an E/M service within 24 hours or the soonest available appointment; in those circumstances, its work is part of that service.

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 99422 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

99422 rates by state

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

How the 99422 rate is calculated

Each of 99422’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 99422

99422 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.

99422 compared with similar codes

How to choose

99421Online E/M5–10 minutes over seven days

Use 99421 when eligible provider time totals the lower tier over seven days; 99422 requires 11–20 minutes.

99423Online E/M21 or more minutes

Use 99423 when eligible provider time reaches its higher tier; 99422 is limited to 11–20 cumulative minutes.

98971Digital assessment11-20 minutes

This is the corresponding online digital assessment time tier for a qualified nonphysician health professional; 99422 is the physician/QHP code family.

99424Principal care managementPhysician/QHP, first 30 minutes

99424 describes principal care management work, not a patient-initiated online evaluation and response measured over a seven-day period.

Codes related to 99422

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