$29.21–$30.12
Both describe established-patient online E/M over seven days. Choose 99421 for 5–10 cumulative minutes and 99422 for 11–20 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
99421 Online E/M Medicare reimbursement rates in Maine
Report 99421 for an established patient’s online, asynchronous evaluation and management when the clinician’s cumulative work totals 5–10 minutes over seven days. Compare 99421 office and facility rates across CMS payment localities in Maine.
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 99421 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$14.91–$15.39
2 of 2 localities have a supported rate.
Facility setting
$10.61–$10.76
2 of 2 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.
Digital evaluation and management
About 99421: Established Patient Online Digital Evaluation
Report 99421 for an established patient’s online, asynchronous evaluation and management when the clinician’s cumulative work totals 5–10 minutes over seven days.
99421 covers a patient-initiated online evaluation and management service for an established patient. A physician or other qualified health care professional may review the patient’s secure portal message, assess the concern, review relevant records, make a management plan, and communicate recommendations or orders electronically. The service is asynchronous; it is not a scheduled video or telephone visit.
Select this level when the clinician’s cumulative time on the online evaluation and management work is 5–10 minutes during the seven-day period. Count the work across the episode rather than reporting separately for each message. Documentation should show the patient’s concern, the clinician’s assessment and management, the communication, and the total time. When the same problem leads to an in-person or other E/M service during the applicable period, the online work is generally included in that E/M service rather than reported separately.
Where the value comes from
- Work RVU0.25 · 53%
- Practice expense (office) RVU0.20 · 43%
- Malpractice RVU0.02 · 4%
89.2K
Medicare services in 2024 · #594 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.
99421 compared with similar codes
Office rates for Maine, from the same CMS release.
$46.50–$47.97
Both describe established-patient online E/M over seven days. Choose 99421 for 5–10 cumulative minutes and 99423 for 21 minutes or more.
Compare 99421 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$14.91
Facility
$10.61
Southern Maine →
Office / nonfacility
$15.39
Facility
$10.76
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99421 billing questions
When should 99421 be chosen over 99422 or 99423?
Use 99421 when cumulative online E/M time is 5–10 minutes over seven days. The higher-level codes are for longer time: 11–20 minutes for 99422 and 21 minutes or more for 99423.
Can each portal message be reported as a separate unit?
No. Combine the clinician’s time for the online E/M work over the seven-day period and report the applicable level once for that episode.
What documentation supports 99421?
Document the established patient’s online concern, the clinician’s evaluation and management, the response or plan, and cumulative time for the seven-day period.
Does 99421 describe a video visit?
No. It describes asynchronous online E/M work, such as review and response through a secure patient portal; it is not a synchronous video encounter.
How does 99421 differ from G2012?
99421 captures a broader online evaluation and management episode with cumulative work over seven days. G2012 describes a brief communication technology-based check-in.
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.
13,09999416,,Prolng clin staff svc ea add,A,,0.00,0.37,,0.37,NA,0.01,0.38,0.38,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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