Billing code 99422: Online E/MMedicare rate & RVUs
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.
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 rate · 99422
Online E/M
Swap in your local Medicare rate.
- Work RVUs
- 0.5
- Total RVUs
- 0.92
- Global days
- XXX
National rate · 2026
$30.73
Office setting, before claim adjustments.
See every locality for 99422 → · 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.
On this page 10 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.
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 payment localities
$28.29 to $39.30
109 of 109 payment localities
99422 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.
$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
Swap in your local Medicare rate.
Work 0.50Practice expense 0.38Malpractice 0.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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).
Non-facility (office) rate · national
$30.73
The facility rate would be $22.38 (+$8.35). In a facility, the facility bills its own costs separately.
99422 compared with similar codes
Compare codes
99422 vs 99421 vs 99423 vs 98971 vs 99424: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99421Online E/M
- Use 99421 when eligible provider time totals the lower tier over seven days; 99422 requires 11–20 minutes.
- 99423Online E/M
- Use 99423 when eligible provider time reaches its higher tier; 99422 is limited to 11–20 cumulative minutes.
- 98971Digital assessment
- This is the corresponding online digital assessment time tier for a qualified nonphysician health professional; 99422 is the physician/QHP code family.
- 99424Principal care management
- 99424 describes principal care management work, not a patient-initiated online evaluation and response measured over a seven-day period.
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
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