CPT code 99422: Online E/M, established patient, 11–20 minutes2026 Medicare rate & RVUs in Virginia
Reports an established-patient online evaluation and management service when the physician or qualified health professional spends 11–20 cumulative minutes managing the request over seven days.
In Virginia, Medicare pays $30.12 for 99422 in the office and $21.91 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 99422 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Virginia compares for 99422
Across 109 of 109 payment localities, the office rate for 99422 runs from $28.29 in Arkansas to $39.30 in Alaska. Virginia pays $30.12. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virginia · this page$30.12
- Los Angeles, CA · California$33.29+$3.17
- Washington, DC area · District of Columbia$34.04+$3.92
- Miami, FL · Florida$33.29+$3.17
- Chicago, IL · Illinois$32.64+$2.52
- Manhattan, NY · New York$34.64+$4.52
- Alaska · Alaska$39.30+$9.18
Other areas in Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $28.56 | $21.26 |
| ArkansasArkansas | $28.29 | $21.12 |
| ArizonaArizona | $30.14 | $22.05 |
| Bakersfield, CACalifornia | $31.74 | $22.59 |
| Chico, CACalifornia | $31.61 | $22.46 |
| El Centro, CACalifornia | $31.62 | $22.47 |
| Fresno, CACalifornia | $31.61 | $22.46 |
| Hanford, CACalifornia | $31.61 | $22.46 |
| Madera, CACalifornia | $31.61 | $22.46 |
| Merced, CACalifornia | $31.61 | $22.46 |
| Modesto, CACalifornia | $31.61 | $22.46 |
| Napa, CACalifornia | $35.16 | $24.15 |
| Oxnard, CACalifornia | $33.00 | $23.13 |
| Redding, CACalifornia | $31.61 | $22.46 |
| Rest of CaliforniaCalifornia | $31.61 | $22.46 |
| Riverside, CACalifornia | $32.05 | $22.90 |
| Sacramento, CACalifornia | $32.78 | $23.07 |
| Salinas, CACalifornia | $32.64 | $22.97 |
| San Diego, CACalifornia | $33.11 | $23.12 |
| Marin County, CACalifornia | $36.80 | $25.02 |
| San Francisco, CACalifornia | $36.75 | $24.98 |
| San Benito County, CACalifornia | $37.56 | $25.51 |
| Santa Clara County, CACalifornia | $37.37 | $25.33 |
| San Luis Obispo, CACalifornia | $32.16 | $22.65 |
| Santa Cruz, CACalifornia | $33.19 | $23.04 |
| Santa Maria, CACalifornia | $32.68 | $22.95 |
| Santa Rosa, CACalifornia | $33.50 | $23.25 |
| Stockton, CACalifornia | $31.61 | $22.46 |
| Vallejo, CACalifornia | $35.09 | $24.09 |
| Visalia, CACalifornia | $31.61 | $22.46 |
| Yuba City, CACalifornia | $31.61 | $22.46 |
| ColoradoColorado | $31.45 | $22.56 |
| ConnecticutConnecticut | $32.32 | $23.33 |
| DelawareDelaware | $30.53 | $22.28 |
| Fort Lauderdale, FLFlorida | $31.97 | $23.51 |
| Rest of FloridaFlorida | $30.84 | $22.86 |
| Atlanta, GAGeorgia | $31.25 | $22.77 |
| Rest of GeorgiaGeorgia | $29.61 | $22.17 |
| Hawaii, Guam, HIHawaii | $31.91 | $22.41 |
| IowaIowa | $28.84 | $21.20 |
| IdahoIdaho | $29.01 | $21.33 |
| East St. Louis, ILIllinois | $31.07 | $23.39 |
| Rest of IllinoisIllinois | $30.38 | $22.75 |
| Suburban Chicago, ILIllinois | $32.22 | $23.64 |
| IndianaIndiana | $29.12 | $21.37 |
| KansasKansas | $28.85 | $21.30 |
| KentuckyKentucky | $29.21 | $21.78 |
| New Orleans, LALouisiana | $30.16 | $22.30 |
| Rest of LouisianaLouisiana | $29.21 | $21.82 |
| Metropolitan Boston, MAMassachusetts | $33.73 | $23.76 |
| Rest of MassachusettsMassachusetts | $31.40 | $22.60 |
| Baltimore area, MDMaryland | $32.24 | $23.28 |
| Rest of MarylandMaryland | $30.94 | $22.49 |
| Rest of MaineMaine | $29.21 | $21.53 |
| Southern Maine, MEMaine | $30.12 | $21.85 |
| Detroit, MIMichigan | $31.20 | $23.14 |
| Rest of MichiganMichigan | $29.80 | $22.17 |
| MinnesotaMinnesota | $30.16 | $21.56 |
| Metropolitan Kansas City, MOMissouri | $29.92 | $22.08 |
| Metropolitan St. Louis, MOMissouri | $30.12 | $22.17 |
| Rest of MissouriMissouri | $28.94 | $21.74 |
| MississippiMississippi | $28.62 | $21.43 |
| MontanaMontana | $30.73 | $22.38 |
| North CarolinaNorth Carolina | $29.40 | $21.61 |
| North DakotaNorth Dakota | $29.94 | $21.58 |
| NebraskaNebraska | $28.92 | $21.21 |
| New HampshireNew Hampshire | $31.08 | $22.39 |
| Northern New JerseyNew Jersey | $33.90 | $24.22 |
| Rest of New JerseyNew Jersey | $32.69 | $23.58 |
| New MexicoNew Mexico | $29.94 | $22.29 |
| NevadaNevada | $30.52 | $22.16 |
| NYC suburbs and Long Island, NYNew York | $35.34 | $25.41 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $32.97 | $23.82 |
| Queens, NYNew York | $34.70 | $24.83 |
| Rest of New YorkNew York | $29.70 | $21.76 |
| OhioOhio | $29.64 | $22.01 |
| OklahomaOklahoma | $29.07 | $21.62 |
| Portland, OROregon | $32.06 | $22.79 |
| Rest of OregonOregon | $30.28 | $21.96 |
| Metropolitan Philadelphia, PAPennsylvania | $31.81 | $23.12 |
| Rest of PennsylvaniaPennsylvania | $29.61 | $21.95 |
| Puerto RicoPuerto Rico | $30.85 | $22.41 |
| Rhode IslandRhode Island | $31.32 | $22.69 |
| South CarolinaSouth Carolina | $29.56 | $21.85 |
| South DakotaSouth Dakota | $29.84 | $21.49 |
| TennesseeTennessee | $28.96 | $21.36 |
| Austin, TXTexas | $31.35 | $22.51 |
| Beaumont, TXTexas | $29.49 | $21.89 |
| Brazoria, TXTexas | $30.45 | $22.18 |
| Dallas, TXTexas | $30.64 | $22.32 |
| Fort Worth, TXTexas | $30.53 | $22.30 |
| Galveston, TXTexas | $30.54 | $22.25 |
| Houston, TXTexas | $31.28 | $22.98 |
| Rest of TexasTexas | $29.95 | $22.03 |
| UtahUtah | $29.83 | $21.98 |
| Virgin Islands, VIUnited States Virgin Islands | $30.85 | $22.41 |
| VermontVermont | $29.94 | $21.68 |
| Rest of WashingtonWashington | $31.30 | $22.51 |
| King County, WAWashington | $34.20 | $23.95 |
| WisconsinWisconsin | $29.27 | $21.27 |
| West VirginiaWest Virginia | $29.64 | $22.39 |
| WyomingWyoming | $30.38 | $22.03 |
99422 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$28.29
$39.30
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $39.30 | 1 |
| AL | $28.56 | 1 |
| AR | $28.29 | 1 |
| AZ | $30.14 | 1 |
| CA | $31.61–$37.56 | 29 |
| CO | $31.45 | 1 |
| CT | $32.32 | 1 |
| DC | $34.04 | 1 |
| DE | $30.53 | 1 |
| FL | $30.84–$33.29 | 3 |
| GA | $29.61–$31.25 | 2 |
| GU | $31.91 | 1 |
| HI | $31.91 | 1 |
| IA | $28.84 | 1 |
| ID | $29.01 | 1 |
| IL | $30.38–$32.64 | 4 |
| IN | $29.12 | 1 |
| KS | $28.85 | 1 |
| KY | $29.21 | 1 |
| LA | $29.21–$30.16 | 2 |
| MA | $31.40–$33.73 | 2 |
| MD | $30.94–$34.04 | 3 |
| ME | $29.21–$30.12 | 2 |
| MI | $29.80–$31.20 | 2 |
| MN | $30.16 | 1 |
| MO | $28.94–$30.12 | 3 |
| MS | $28.62 | 1 |
| MT | $30.73 | 1 |
| NC | $29.40 | 1 |
| ND | $29.94 | 1 |
| NE | $28.92 | 1 |
| NH | $31.08 | 1 |
| NJ | $32.69–$33.90 | 2 |
| NM | $29.94 | 1 |
| NV | $30.52 | 1 |
| NY | $29.70–$35.34 | 5 |
| OH | $29.64 | 1 |
| OK | $29.07 | 1 |
| OR | $30.28–$32.06 | 2 |
| PA | $29.61–$31.81 | 2 |
| PR | $30.85 | 1 |
| RI | $31.32 | 1 |
| SC | $29.56 | 1 |
| SD | $29.84 | 1 |
| TN | $28.96 | 1 |
| TX | $29.49–$31.35 | 8 |
| UT | $29.83 | 1 |
| VA | $30.12–$34.04 | 2 |
| VI | $30.85 | 1 |
| VT | $29.94 | 1 |
| WA | $31.30–$34.20 | 2 |
| WI | $29.27 | 1 |
| WV | $29.64 | 1 |
| WY | $30.38 | 1 |
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.
How the rate is built · 99422
RVUs × geographic indexes × conversion factor
Work0.50
0.50 RVUs× 1.000 GPCI
Practice expense0.38
0.38 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
0.9200
Conversion factor
$33.4009
Medicare rate
$30.73
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
13,103
- Code
- 99422
- Physician work
- 0.50
- Practice expense
- 0.38
- Malpractice
- 0.04
GPCI2026.csv
106
- Locality
- Virginia
- Physician work
- 1.000
- Practice expense
- 0.983
- Malpractice
- 0.706
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.50 | × 1.000 | 0.5000 |
| Practice expense | 0.38 | × 0.983 | 0.3735 |
| Malpractice | 0.04 | × 0.706 | 0.0282 |
| Total RVUs | 0.9018 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virginia$30.12
Office: (0.5 × 1 + 0.38 × 0.983 + 0.04 × 0.706) × $33.4009 = $30.12
Facility: (0.5 × 1 + 0.13 × 0.983 + 0.04 × 0.706) × $33.4009 = $21.91
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.
Place of service · 99422
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$30.73
- Non-facility (office)
- $30.73
- Facility
- $22.38
Higher because the practice carries its own overhead.
How 99422 has changed in Virginia
99422 · Office / nonfacility
$30.12
Effective 2026-10-01
The base rate is $2.12 higher than on 2025-10-01, moving from $28.00 to $30.12 (7.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$28.00changed to$30.12
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.34 changed to 0.38
- Work GPCI 1.002 changed to 1.000
- Practice expense GPCI 0.984 changed to 0.983
- Malpractice GPCI 0.755 changed to 0.706
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$28.82changed to$28.00
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$28.35changed to$28.82
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$29.13changed to$28.35
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.33 changed to 0.34
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 0.990 changed to 0.984
- Malpractice GPCI 0.826 changed to 0.755
January 1, 2023
RVU23A
$29.56changed to$29.13
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.32 changed to 0.33
- Practice expense GPCI 0.995 changed to 0.990
- Malpractice GPCI 0.897 changed to 0.826
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$29.81changed to$29.56
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$30.76changed to$29.81
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.31 changed to 0.32
- Malpractice RVU 0.05 changed to 0.04
- Practice expense GPCI 0.991 changed to 0.995
- Malpractice GPCI 0.903 changed to 0.897
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
No ratechanged to$30.76
Held through RVU20B, RVU20C, RVU20D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $30.12 | $21.91 | RVU26D |
| 2026-07-01 | $30.12 | $21.91 | RVU26C |
| 2026-04-01 | $30.12 | $21.91 | RVU26B |
| 2026-01-01 | $30.12 | $21.91 | RVU26A |
| 2025-10-01 | $28.00 | $24.18 | RVU25D |
| 2025-07-01 | $28.00 | $24.18 | RVU25C |
| 2025-04-01 | $28.00 | $24.18 | RVU25B |
| 2025-01-01 | $28.00 | $24.18 | RVU25A |
| 2024-10-01 | $28.82 | $24.56 | RVU24D |
| 2024-07-01 | $28.82 | $24.56 | RVU24C |
| 2024-04-01 | $28.82 | $24.56 | RVU24B |
| 2024-03-09 | $28.82 | $24.56 | RVU24AR |
| 2024-01-01 | $28.35 | $24.16 | RVU24A |
| 2023-10-01 | $29.13 | $25.11 | RVU23D |
| 2023-07-01 | $29.13 | $25.11 | RVU23C |
| 2023-04-01 | $29.13 | $25.11 | RVU23B |
| 2023-01-01 | $29.13 | $25.11 | RVU23A |
| 2022-10-01 | $29.56 | $25.78 | RVU22D |
| 2022-07-01 | $29.56 | $25.78 | RVU22C |
| 2022-04-01 | $29.56 | $25.78 | RVU22B |
| 2022-01-01 | $29.56 | $25.78 | RVU22A |
| 2021-10-01 | $29.81 | $25.99 | RVU21D |
| 2021-07-01 | $29.81 | $25.99 | RVU21C |
| 2021-04-01 | $29.81 | $25.99 | RVU21B |
| 2021-01-01 | $29.81 | $25.99 | RVU21A |
| 2020-10-01 | $30.76 | $27.18 | RVU20D |
| 2020-07-01 | $30.76 | $27.18 | RVU20C |
| 2020-04-01 | $30.76 | $27.18 | RVU20B |
| 2020-01-01 | $30.76 | $27.18 | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Virginia rate applies
Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.
- Abbs Valley
- Abingdon
- Accomac
- Adwolf
- Afton
- Alberta
- Aldie
- Allison Gap
99422 billing questions
How is 99422 different from 99421 or 99423?
The distinction is the physician’s or qualified health professional’s cumulative time over the seven-day period: 99422 covers 11–20 minutes. Use 99421 for the lower time tier and 99423 for the higher tier.
Can multiple portal messages be counted together?
Yes. Count the provider’s eligible work across the seven-day period and report one code at the tier supported by the cumulative time, rather than billing each message separately.
Does staff time count toward 99422?
No. The time threshold is based on the physician’s or other qualified health professional’s work; staff handling or routing the portal message does not establish the provider time.
What documentation supports the service?
Document the patient’s online request, the issue evaluated, the provider’s assessment and response, and the dates and cumulative provider time supporting the 11–20-minute tier.
Can 99422 be reported when the patient has an office visit shortly afterward?
If the online work leads to an E/M service within 24 hours or the soonest available appointment, it is included in that service rather than separately reported as 99422.
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
Fee sheets · Coming soon
Put 99422 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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