$15.49–$16.66
Use 99421 when eligible provider time totals the lower tier over seven days; 99422 requires 11–20 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
99422 Online E/M Medicare reimbursement rates in Illinois
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. Compare 99422 office and facility rates across CMS payment localities in Illinois.
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.
What does Medicare pay for 99422 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$30.38–$32.64
4 of 4 localities have a supported rate.
Facility setting
$22.75–$24.25
4 of 4 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 99422 pays more and less in Illinois
4 payment localities
$30.38 to $32.64
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 Illinois, from the same CMS release.
$47.93–$51.22
Use 99423 when eligible provider time reaches its higher tier; 99422 is limited to 11–20 cumulative minutes.
$22.75–$24.05
This is the corresponding online digital assessment time tier for a qualified nonphysician health professional; 99422 is the physician/QHP code family.
$86.50–$92.78
99424 describes principal care management work, not a patient-initiated online evaluation and response measured over a seven-day period.
Compare 99422 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
4 of 4 payment localities
Chicago →
Office / nonfacility
$32.64
Facility
$24.25
East St. Louis →
Office / nonfacility
$31.07
Facility
$23.39
Rest Of Illinois →
Office / nonfacility
$30.38
Facility
$22.75
Suburban Chicago →
Office / nonfacility
$32.22
Facility
$23.64
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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.
13,10099417,,Prolng op e/m each 15 min,I,+,0.61,0.31,,0.14,,0.04,0.96,0.79,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10199418,,Prolng ip/obs e/m ea 15 min,I,+,0.81,0.18,NA,0.18,,0.05,1.04,1.04,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10299421,,Ol dig e/m svc 5-10 min,A,,0.25,0.20,,0.06,,0.02,0.47,0.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10399422,,Ol dig e/m svc 11-20 min,A,,0.50,0.38,,0.13,,0.04,0.92,0.67,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10499423,,Ol dig e/m svc 21+ min,A,,0.80,0.61,,0.20,,0.05,1.46,1.05,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10599424,,Prin care mgmt phys 1st 30,A,,1.45,1.06,,0.38,,0.11,2.62,1.94,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10699425,,Prin care mgmt phys ea addl,A,,1.00,0.77,,0.25,,0.07,1.84,1.32,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00