CPT code 99423: Online E/M, 21 or more minutes2026 Medicare rate & RVUs
Reports an established-patient, patient-initiated online evaluation and management episode when the qualified professional’s cumulative work reaches 21 minutes.
Medicare pays $48.77 for 99423 nationally in the office and $35.07 in a hospital or facility. Local office rates run $45.08–$62.70.
Medicare rate · 99423
Online E/M, 21 or more minutes
- Work RVUs
- 0.8
- Total RVUs
- 1.46
- Global days
- XXX
National rate · 2026
$48.77
Office setting, before claim adjustments.
See every locality for 99423 →Billed by an NP, PA or therapist? →
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 10 sections
What 99423 covers
A physician or other qualified health professional reviews patient-initiated messages through a secure online portal, assesses a concern, and responds with clinical advice, orders, or a treatment plan. The service is for an established patient whose issue can be handled asynchronously rather than through a real-time visit. Professional work can include reviewing relevant records and composing the clinical response; staff-only message handling is not the professional service represented by this code.
Select this level when the professional’s cumulative time for the online E/M episode is 21 minutes or more within seven days. Do not count each message as a separate service: document the patient’s request, dates of work, clinical assessment and response, and total professional minutes for the episode. CMS fee schedule valuation includes work and malpractice RVUs, with separate office and facility practice-expense inputs.
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 99423 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$45.08 to $62.70
109 of 109 payment localities
99423 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$45.08
$62.70
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 | $62.70 | 1 |
| AL | $45.49 | 1 |
| AR | $45.08 | 1 |
| AZ | $47.89 | 1 |
| CA | $50.40–$59.94 | 29 |
| CO | $50.02 | 1 |
| CT | $51.22 | 1 |
| DC | $54.02 | 1 |
| DE | $48.49 | 1 |
| FL | $48.71–$52.15 | 3 |
| GA | $46.89–$49.51 | 2 |
| GU | $50.85 | 1 |
| HI | $50.85 | 1 |
| IA | $46.03 | 1 |
| ID | $46.26 | 1 |
| IL | $47.93–$51.22 | 4 |
| IN | $46.42 | 1 |
| KS | $45.98 | 1 |
| KY | $46.36 | 1 |
| LA | $46.35–$47.79 | 2 |
| MA | $49.93–$53.63 | 2 |
| MD | $49.14–$54.02 | 3 |
| ME | $46.50–$47.97 | 2 |
| MI | $47.21–$49.20 | 2 |
| MN | $48.18 | 1 |
| MO | $45.91–$47.79 | 3 |
| MS | $45.50 | 1 |
| MT | $48.76 | 1 |
| NC | $46.80 | 1 |
| ND | $47.77 | 1 |
| NE | $46.16 | 1 |
| NH | $49.39 | 1 |
| NJ | $51.87–$53.82 | 2 |
| NM | $47.41 | 1 |
| NV | $48.51 | 1 |
| NY | $47.25–$55.76 | 5 |
| OH | $47.01 | 1 |
| OK | $46.21 | 1 |
| OR | $48.19–$51.03 | 2 |
| PA | $47.00–$50.40 | 2 |
| PR | $48.96 | 1 |
| RI | $49.77 | 1 |
| SC | $46.97 | 1 |
| SD | $47.66 | 1 |
| TN | $46.14 | 1 |
| TX | $46.81–$49.81 | 8 |
| UT | $47.37 | 1 |
| VA | $47.93–$54.02 | 2 |
| VI | $48.96 | 1 |
| VT | $47.74 | 1 |
| WA | $49.79–$54.42 | 2 |
| WI | $46.75 | 1 |
| WV | $46.82 | 1 |
| WY | $48.33 | 1 |
How the 99423 rate is calculated
Each of 99423’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 · 99423
RVUs × geographic indexes × conversion factor
Work0.80
0.80 RVUs× 1.000 GPCI
Practice expense0.61
0.61 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.4600
Conversion factor
$33.4009
Medicare rate
$48.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99423
99423 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 · 99423
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$48.77
- Non-facility (office)
- $48.77
- Facility
- $35.07
Higher because the practice carries its own overhead.
99423 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99421Online E/M5–10 minutes over seven days
- Both cover patient-initiated online E/M for established patients; 99421 is selected for 5 through 10 cumulative minutes, while 99423 requires 21 minutes or more.
- 99422Online E/MEstablished patient, 11–20 minutes
- 99422 covers 11 through 20 cumulative minutes of the online E/M episode. Use 99423 when the professional’s documented time reaches at least 21 minutes.
- 99424Principal care managementPhysician/QHP, first 30 minutes
- 99424 represents physician or qualified professional principal care management, not an episodic patient-initiated online assessment and response.
- 99417Prolonged E/MOffice or outpatient
- 99417 is an add-on for qualifying prolonged office or outpatient E/M service time. It does not represent time spent handling an asynchronous portal exchange.
99423 billing questions
How does 99423 differ from 99422?
Both represent patient-initiated online E/M for an established patient. Choose 99423 when cumulative professional time reaches 21 minutes or more within seven days; 99422 is for 11 through 20 minutes.
Can each portal message be billed separately?
No. Treat the work as a seven-day episode and select the level using the cumulative professional time, even when the exchange includes multiple messages.
What time should be documented?
Document the qualified professional’s total time spent on the online evaluation and management work during the seven-day period. The record should also show the patient’s request, the clinical issue, and the resulting assessment and response.
Can clinical staff time support 99423?
The code represents the physician’s or other qualified health professional’s online E/M work. Staff-only message handling does not establish the professional time for this level.
When should 99421 be selected instead?
Use 99421 for the same type of online E/M episode when cumulative professional time is 5 through 10 minutes. The time threshold, not the number of messages, distinguishes the level.
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
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