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CMS RVU26D · Effective 2026-10-01

99422 in Merced

Office / nonfacility

$31.61

Base rate per service

Facility setting

$22.46

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Online evaluation and management

About 99422: Established-patient digital E/M, 11–20 minutes

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.

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.

Where the value comes from

  • Work RVU0.50 · 54%
  • Practice expense (office) RVU0.38 · 41%
  • Malpractice RVU0.04 · 4%

40.9K

Medicare services in 2024 · #862 by national volume

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.

99422 compared with similar codes

Office rates for Merced, from the same CMS release.

99421

Online E/M

5–10 minutes over seven days

$16.17

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

99423

Online E/M

21 or more minutes

$50.40

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

98971

Digital assessment

11-20 minutes

$23.72

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

99424

Principal care management

Physician/QHP, first 30 minutes

$90.03

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

The same code, a different location

How does Merced compare?

In Bakersfield, the office rate for 99422 is $31.74—$0.13 higher than the $31.61 rate in Merced. Both use the same code, release and participation basis.

99422 across payment areas

Same release and payment basis · bars start at $0

  1. Merced · This locality

    $31.61

  2. Bakersfield

    $31.74

    $0.13 higher than Merced

  3. Chico

    $31.61

    The same base rate than Merced

  4. El Centro

    $31.62

    $0.01 higher than Merced

  5. Fresno

    $31.61

    The same base rate than Merced

  6. Hanford-Corcoran

    $31.61

    The same base rate than Merced

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $33.29

    $1.68 higher than Merced

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 99422 ranges from $28.29 in Arkansas to $39.30 in Alaska*. This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Modesto

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Napa

    California · 99422

    Office

    $35.16

    Facility

    $24.15

    $3.55 higher than Merced for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 99422

    Office

    $33.00

    Facility

    $23.13

    $1.39 higher than Merced for the office setting.

  • Redding

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Rest Of California

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 99422

    Office

    $32.05

    Facility

    $22.90

    $0.44 higher than Merced for the office setting.

  • Sacramento-Roseville-Folsom

    California · 99422

    Office

    $32.78

    Facility

    $23.07

    $1.17 higher than Merced for the office setting.

  • Salinas

    California · 99422

    Office

    $32.64

    Facility

    $22.97

    $1.03 higher than Merced for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 99422

    Office

    $33.11

    Facility

    $23.12

    $1.50 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 99422

    Office

    $36.80

    Facility

    $25.02

    $5.19 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 99422

    Office

    $36.75

    Facility

    $24.98

    $5.14 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 99422

    Office

    $37.56

    Facility

    $25.51

    $5.95 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 99422

    Office

    $37.37

    Facility

    $25.33

    $5.76 higher than Merced for the office setting.

  • San Luis Obispo-Paso Robles

    California · 99422

    Office

    $32.16

    Facility

    $22.65

    $0.55 higher than Merced for the office setting.

  • Santa Cruz-Watsonville

    California · 99422

    Office

    $33.19

    Facility

    $23.04

    $1.58 higher than Merced for the office setting.

  • Santa Maria-Santa Barbara

    California · 99422

    Office

    $32.68

    Facility

    $22.95

    $1.07 higher than Merced for the office setting.

  • Santa Rosa-Petaluma

    California · 99422

    Office

    $33.50

    Facility

    $23.25

    $1.89 higher than Merced for the office setting.

  • Stockton

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Vallejo

    California · 99422

    Office

    $35.09

    Facility

    $24.09

    $3.48 higher than Merced for the office setting.

  • Visalia

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Yuba City

    California · 99422

    Office

    $31.61

    Facility

    $22.46

    The same base rate than Merced for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 99422

    Office

    $34.04

    Facility

    $24.20

    $2.43 higher than Merced for the office setting.

  • Miami

    Florida · 99422

    Office

    $33.29

    Facility

    $24.60

    $1.68 higher than Merced for the office setting.

  • Chicago

    Illinois · 99422

    Office

    $32.64

    Facility

    $24.25

    $1.03 higher than Merced for the office setting.

  • Manhattan

    New York · 99422

    Office

    $34.64

    Facility

    $24.93

    $3.03 higher than Merced for the office setting.

  • Alaska*

    Alaska · 99422

    Office

    $39.30

    Facility

    $30.41

    $7.69 higher than Merced for the office setting.

  • Alabama

    Alabama · 99422

    Office

    $28.56

    Facility

    $21.26

    $3.05 lower than Merced for the office setting.

  • Arkansas

    Arkansas · 99422

    Office

    $28.29

    Facility

    $21.12

    $3.32 lower than Merced for the office setting.

  • Arizona

    Arizona · 99422

    Office

    $30.14

    Facility

    $22.05

    $1.47 lower than Merced for the office setting.

  • Colorado

    Colorado · 99422

    Office

    $31.45

    Facility

    $22.56

    $0.16 lower than Merced for the office setting.

  • Connecticut

    Connecticut · 99422

    Office

    $32.32

    Facility

    $23.33

    $0.71 higher than Merced for the office setting.

  • Delaware

    Delaware · 99422

    Office

    $30.53

    Facility

    $22.28

    $1.08 lower than Merced for the office setting.

  • Fort Lauderdale

    Florida · 99422

    Office

    $31.97

    Facility

    $23.51

    $0.36 higher than Merced for the office setting.

  • Rest Of Florida

    Florida · 99422

    Office

    $30.84

    Facility

    $22.86

    $0.77 lower than Merced for the office setting.

  • Atlanta

    Georgia · 99422

    Office

    $31.25

    Facility

    $22.77

    $0.36 lower than Merced for the office setting.

  • Rest Of Georgia

    Georgia · 99422

    Office

    $29.61

    Facility

    $22.17

    $2.00 lower than Merced for the office setting.

  • Hawaii, Guam

    Hawaii · 99422

    Office

    $31.91

    Facility

    $22.41

    $0.30 higher than Merced for the office setting.

  • Iowa

    Iowa · 99422

    Office

    $28.84

    Facility

    $21.20

    $2.77 lower than Merced for the office setting.

  • Idaho

    Idaho · 99422

    Office

    $29.01

    Facility

    $21.33

    $2.60 lower than Merced for the office setting.

  • East St. Louis

    Illinois · 99422

    Office

    $31.07

    Facility

    $23.39

    $0.54 lower than Merced for the office setting.

  • Rest Of Illinois

    Illinois · 99422

    Office

    $30.38

    Facility

    $22.75

    $1.23 lower than Merced for the office setting.

  • Suburban Chicago

    Illinois · 99422

    Office

    $32.22

    Facility

    $23.64

    $0.61 higher than Merced for the office setting.

  • Indiana

    Indiana · 99422

    Office

    $29.12

    Facility

    $21.37

    $2.49 lower than Merced for the office setting.

  • Kansas

    Kansas · 99422

    Office

    $28.85

    Facility

    $21.30

    $2.76 lower than Merced for the office setting.

  • Kentucky

    Kentucky · 99422

    Office

    $29.21

    Facility

    $21.78

    $2.40 lower than Merced for the office setting.

  • New Orleans

    Louisiana · 99422

    Office

    $30.16

    Facility

    $22.30

    $1.45 lower than Merced for the office setting.

  • Rest Of Louisiana

    Louisiana · 99422

    Office

    $29.21

    Facility

    $21.82

    $2.40 lower than Merced for the office setting.

  • Metropolitan Boston

    Massachusetts · 99422

    Office

    $33.73

    Facility

    $23.76

    $2.12 higher than Merced for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 99422

    Office

    $31.40

    Facility

    $22.60

    $0.21 lower than Merced for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 99422

    Office

    $32.24

    Facility

    $23.28

    $0.63 higher than Merced for the office setting.

  • Rest Of Maryland

    Maryland · 99422

    Office

    $30.94

    Facility

    $22.49

    $0.67 lower than Merced for the office setting.

  • Rest Of Maine

    Maine · 99422

    Office

    $29.21

    Facility

    $21.53

    $2.40 lower than Merced for the office setting.

  • Southern Maine

    Maine · 99422

    Office

    $30.12

    Facility

    $21.85

    $1.49 lower than Merced for the office setting.

  • Detroit

    Michigan · 99422

    Office

    $31.20

    Facility

    $23.14

    $0.41 lower than Merced for the office setting.

  • Rest Of Michigan

    Michigan · 99422

    Office

    $29.80

    Facility

    $22.17

    $1.81 lower than Merced for the office setting.

  • Minnesota

    Minnesota · 99422

    Office

    $30.16

    Facility

    $21.56

    $1.45 lower than Merced for the office setting.

  • Metropolitan Kansas City

    Missouri · 99422

    Office

    $29.92

    Facility

    $22.08

    $1.69 lower than Merced for the office setting.

  • Metropolitan St. Louis

    Missouri · 99422

    Office

    $30.12

    Facility

    $22.17

    $1.49 lower than Merced for the office setting.

  • Rest Of Missouri

    Missouri · 99422

    Office

    $28.94

    Facility

    $21.74

    $2.67 lower than Merced for the office setting.

  • Mississippi

    Mississippi · 99422

    Office

    $28.62

    Facility

    $21.43

    $2.99 lower than Merced for the office setting.

  • Montana**

    Montana · 99422

    Office

    $30.73

    Facility

    $22.38

    $0.88 lower than Merced for the office setting.

  • North Carolina

    North Carolina · 99422

    Office

    $29.40

    Facility

    $21.61

    $2.21 lower than Merced for the office setting.

  • North Dakota**

    North Dakota · 99422

    Office

    $29.94

    Facility

    $21.58

    $1.67 lower than Merced for the office setting.

  • Nebraska

    Nebraska · 99422

    Office

    $28.92

    Facility

    $21.21

    $2.69 lower than Merced for the office setting.

  • New Hampshire

    New Hampshire · 99422

    Office

    $31.08

    Facility

    $22.39

    $0.53 lower than Merced for the office setting.

  • Northern Nj

    New Jersey · 99422

    Office

    $33.90

    Facility

    $24.22

    $2.29 higher than Merced for the office setting.

  • Rest Of New Jersey

    New Jersey · 99422

    Office

    $32.69

    Facility

    $23.58

    $1.08 higher than Merced for the office setting.

  • New Mexico

    New Mexico · 99422

    Office

    $29.94

    Facility

    $22.29

    $1.67 lower than Merced for the office setting.

  • Nevada**

    Nevada · 99422

    Office

    $30.52

    Facility

    $22.16

    $1.09 lower than Merced for the office setting.

  • Nyc Suburbs/Long Island

    New York · 99422

    Office

    $35.34

    Facility

    $25.41

    $3.73 higher than Merced for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 99422

    Office

    $32.97

    Facility

    $23.82

    $1.36 higher than Merced for the office setting.

  • Queens

    New York · 99422

    Office

    $34.70

    Facility

    $24.83

    $3.09 higher than Merced for the office setting.

  • Rest Of New York

    New York · 99422

    Office

    $29.70

    Facility

    $21.76

    $1.91 lower than Merced for the office setting.

  • Ohio

    Ohio · 99422

    Office

    $29.64

    Facility

    $22.01

    $1.97 lower than Merced for the office setting.

  • Oklahoma

    Oklahoma · 99422

    Office

    $29.07

    Facility

    $21.62

    $2.54 lower than Merced for the office setting.

  • Portland

    Oregon · 99422

    Office

    $32.06

    Facility

    $22.79

    $0.45 higher than Merced for the office setting.

  • Rest Of Oregon

    Oregon · 99422

    Office

    $30.28

    Facility

    $21.96

    $1.33 lower than Merced for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 99422

    Office

    $31.81

    Facility

    $23.12

    $0.20 higher than Merced for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 99422

    Office

    $29.61

    Facility

    $21.95

    $2.00 lower than Merced for the office setting.

  • Puerto Rico

    Puerto Rico · 99422

    Office

    $30.85

    Facility

    $22.41

    $0.76 lower than Merced for the office setting.

  • Rhode Island

    Rhode Island · 99422

    Office

    $31.32

    Facility

    $22.69

    $0.29 lower than Merced for the office setting.

  • South Carolina

    South Carolina · 99422

    Office

    $29.56

    Facility

    $21.85

    $2.05 lower than Merced for the office setting.

  • South Dakota**

    South Dakota · 99422

    Office

    $29.84

    Facility

    $21.49

    $1.77 lower than Merced for the office setting.

  • Tennessee

    Tennessee · 99422

    Office

    $28.96

    Facility

    $21.36

    $2.65 lower than Merced for the office setting.

  • Austin

    Texas · 99422

    Office

    $31.35

    Facility

    $22.51

    $0.26 lower than Merced for the office setting.

  • Beaumont

    Texas · 99422

    Office

    $29.49

    Facility

    $21.89

    $2.12 lower than Merced for the office setting.

  • Brazoria

    Texas · 99422

    Office

    $30.45

    Facility

    $22.18

    $1.16 lower than Merced for the office setting.

  • Dallas

    Texas · 99422

    Office

    $30.64

    Facility

    $22.32

    $0.97 lower than Merced for the office setting.

  • Fort Worth

    Texas · 99422

    Office

    $30.53

    Facility

    $22.30

    $1.08 lower than Merced for the office setting.

  • Galveston

    Texas · 99422

    Office

    $30.54

    Facility

    $22.25

    $1.07 lower than Merced for the office setting.

  • Houston

    Texas · 99422

    Office

    $31.28

    Facility

    $22.98

    $0.33 lower than Merced for the office setting.

  • Rest Of Texas

    Texas · 99422

    Office

    $29.95

    Facility

    $22.03

    $1.66 lower than Merced for the office setting.

  • Utah

    Utah · 99422

    Office

    $29.83

    Facility

    $21.98

    $1.78 lower than Merced for the office setting.

  • Virginia

    Virginia · 99422

    Office

    $30.12

    Facility

    $21.91

    $1.49 lower than Merced for the office setting.

  • Virgin Islands

    United States Virgin Islands · 99422

    Office

    $30.85

    Facility

    $22.41

    $0.76 lower than Merced for the office setting.

  • Vermont

    Vermont · 99422

    Office

    $29.94

    Facility

    $21.68

    $1.67 lower than Merced for the office setting.

  • Rest Of Washington

    Washington · 99422

    Office

    $31.30

    Facility

    $22.51

    $0.31 lower than Merced for the office setting.

  • Seattle (King Cnty)

    Washington · 99422

    Office

    $34.20

    Facility

    $23.95

    $2.59 higher than Merced for the office setting.

  • Wisconsin

    Wisconsin · 99422

    Office

    $29.27

    Facility

    $21.27

    $2.34 lower than Merced for the office setting.

  • West Virginia

    West Virginia · 99422

    Office

    $29.64

    Facility

    $22.39

    $1.97 lower than Merced for the office setting.

  • Wyoming**

    Wyoming · 99422

    Office

    $30.38

    Facility

    $22.03

    $1.23 lower than Merced for the office setting.

See how rates vary across the country

99422 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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 all state and territory rates as a table
State / territoryRate rangeLocalities
AK$39.301
AL$28.561
AR$28.291
AZ$30.141
CA$31.61–$37.5629
CO$31.451
CT$32.321
DC$34.041
DE$30.531
FL$30.84–$33.293
GA$29.61–$31.252
GU$31.911
HI$31.911
IA$28.841
ID$29.011
IL$30.38–$32.644
IN$29.121
KS$28.851
KY$29.211
LA$29.21–$30.162
MA$31.40–$33.732
MD$30.94–$34.043
ME$29.21–$30.122
MI$29.80–$31.202
MN$30.161
MO$28.94–$30.123
MS$28.621
MT$30.731
NC$29.401
ND$29.941
NE$28.921
NH$31.081
NJ$32.69–$33.902
NM$29.941
NV$30.521
NY$29.70–$35.345
OH$29.641
OK$29.071
OR$30.28–$32.062
PA$29.61–$31.812
PR$30.851
RI$31.321
SC$29.561
SD$29.841
TN$28.961
TX$29.49–$31.358
UT$29.831
VA$30.12–$34.042
VI$30.851
VT$29.941
WA$31.30–$34.202
WI$29.271
WV$29.641
WY$30.381

Explore 99422 on the national rate map →

Where does this rate apply?

Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 99422 in Merced, the physician’s office rate is $31.61 and the facility-setting rate is $22.46: a difference of $9.15.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 99422 in Merced. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$34.77

$31.61 × 110% = $34.77

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99422 in Merced.

PPRRVU2026_Oct_nonQPP.csv

13,103

Code
99422
Physician work
0.50
Practice expense
0.38
Malpractice
0.04

GPCI2026.csv

15

Locality
Merced
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 99422 in Merced
ComponentRVULocality factorAdjusted
Physician work0.50× 1.0170.5085
Practice expense0.38× 1.0960.4165
Malpractice0.04× 0.5360.0214
Total RVUs0.9464
Conversion factor× 33.4009

Office / nonfacility rate, Merced$31.61

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 99422 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.51.017
Practice expense0.381.096
Malpractice0.040.536

(0.5 × 1.017 + 0.38 × 1.096 + 0.04 × 0.536) × $33.4009 = $31.61

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.51.017
Practice expense0.131.096
Malpractice0.040.536

(0.5 × 1.017 + 0.13 × 1.096 + 0.04 × 0.536) × $33.4009 = $22.46

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

99422 · Office / nonfacility

$31.61

Effective 2026-10-01

The base rate is $2.47 higher than on 2025-10-01, moving from $29.14 to $31.61 (8.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $29.14changed to$31.61

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.34 changed to 0.38
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $29.14

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$31.61$22.46RVU26D
2026-07-01$31.61$22.46RVU26C
2026-04-01$31.61$22.46RVU26B
2026-01-01$31.61$22.46RVU26A
2025-10-01$29.14$24.90RVU25D
2025-07-01$29.14$24.90RVU25C
2025-04-01$29.14$24.90RVU25B
2025-01-01$29.14$24.90RVU25A

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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 99422PPRRVU2026_Oct_nonQPP.csv, line 13,103 (RVU26D)
Geographic factors for MercedGPCI2026.csv, line 15 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet