$16.71–$17.34
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.
On this page
CMS RVU26D · Effective 2026-10-01
99423 Online E/M Medicare reimbursement rates in New Jersey
Reports an established-patient, patient-initiated online evaluation and management episode when the qualified professional’s cumulative work reaches 21 minutes. Compare 99423 office and facility rates across CMS payment localities in New Jersey.
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 99423 in New Jersey?
New Jersey 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
$51.87–$53.82
2 of 2 localities have a supported rate.
Facility setting
$36.92–$37.94
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.
Evaluation and management
About 99423: Online digital evaluation and management, 21 minutes or more
Reports an established-patient, patient-initiated online evaluation and management episode when the qualified professional’s cumulative work reaches 21 minutes.
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.
Where the value comes from
- Work RVU0.80 · 55%
- Practice expense (office) RVU0.61 · 42%
- Malpractice RVU0.05 · 3%
48.2K
Medicare services in 2024 · #794 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.
99423 compared with similar codes
Office rates for New Jersey, from the same CMS release.
$32.69–$33.90
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.
$93.06–$96.48
99424 represents physician or qualified professional principal care management, not an episodic patient-initiated online assessment and response.
99417
No office rateProlng op e/m each 15 min
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.
Compare 99423 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
Northern Nj →
Office / nonfacility
$53.82
Facility
$37.94
Rest Of New Jersey →
Office / nonfacility
$51.87
Facility
$36.92
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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 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.
13,10199418,,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
13,10799426,,Prin care mgmt staff 1st 30,A,,1.00,0.96,,0.25,,0.07,2.03,1.32,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00