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CMS RVU26D · Effective 2026-10-01
99213 Medicare reimbursement rates in Ohio
Compare 99213 physician payment amounts across CMS localities, including office and facility settings.
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 99213 in Ohio?
Ohio has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$90.97
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
Facility setting
$56.51
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
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.
Understanding the service
99213 and 99214: what changes?
Both concern established-patient office or outpatient evaluation and management. Under the medical-decision-making route, 99213 corresponds to low complexity and 99214 to moderate complexity. Eligible visits can instead be selected using qualifying practitioner time.
99213
This pageLow medical decision making
$90.97
Office base rate · same locality and release
99214
Moderate medical decision making
A diagnosis, medication change or the length of a note does not by itself establish the visit level. The documented service must meet the applicable requirements. The payment difference is useful for comparing a fee schedule; it does not decide which code to bill.
Compare 99213 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.
1 of 1 payment localities
Ohio →
Office / nonfacility
$90.97
Facility
$56.51
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Primary care
Compare office and outpatient evaluation-and-management base rates.
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 99213 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
13,015
- Code
- 99213
- Physician work
- 1.30
- Practice expense
- 1.46
- Malpractice
- 0.09
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.30 | × 1.000 | 1.3000 |
| Practice expense | 1.46 | × 0.913 | 1.3330 |
| Malpractice | 0.09 | × 1.008 | 0.0907 |
| Total RVUs | 2.7237 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Ohio$90.97
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.3 | 1 |
| Practice expense | 1.46 | 0.913 |
| Malpractice | 0.09 | 1.008 |
(1.3 × 1 + 1.46 × 0.913 + 0.09 × 1.008) × $33.4009 = $90.97
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.3 | 1 |
| Practice expense | 0.33 | 0.913 |
| Malpractice | 0.09 | 1.008 |
(1.3 × 1 + 0.33 × 0.913 + 0.09 × 1.008) × $33.4009 = $56.51
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.
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.