Billing code 99474: Blood pressure monitoringMedicare rate & RVUs in Ohio
Report this service for a completed 30-day period of twice-daily patient blood pressure readings, averaged and communicated with a treatment plan.
Medicare pays $17.33 for 99474 in the office in Ohio (Ohio). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 99474 covers
This service covers review of a patient’s self-measured blood pressure readings over 30 days, reporting the average systolic and diastolic pressures, and communicating a treatment plan. It is commonly used in outpatient hypertension care when a clinician needs home readings to assess blood pressure control or guide management. The patient or caregiver takes the readings at home; the treating physician or other qualified health care professional reviews the data and communicates the plan.
Report the service for the 30-day monitoring period, not for each individual reading. Documentation should support the monitoring period, the required pattern of at least two readings daily, the calculated averages, and communication of the treatment plan to the patient. The Medicare Physician Fee Schedule assigns work, practice-expense, and malpractice values to the service, with office and facility practice-expense values reported separately. The code represents the monitoring review and communication work for the period.
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.
99474 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $17.33 | $7.87 |
How the 99474 rate is calculated
Each of 99474’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99474
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.18Practice expense 0.36Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99474
99474 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99474
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$18.37
The facility rate would be $8.02 (+$10.35). In a facility, the facility bills its own costs separately.
99474 compared with similar codes
Compare codes
99474 vs 99473 vs 99470 vs 99457: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99473BP device training
- Choose 99473 for patient education and device setup. Choose this code for the 30-day collection and review of readings, averages, and treatment-plan communication.
- 99470RPM management
- 99470 describes remote physiologic monitoring treatment management with a time-based structure. This code is specific to self-measured blood pressure data collected over 30 days.
- 99457RPM management
- 99457 is a remote physiologic monitoring treatment-management service. This code instead requires the specified pattern of self-measured blood pressure readings and reporting of their averages.
99474 billing questions
How is this different from 99473?
99473 covers patient education and device setup. This code covers review and reporting of the readings, including averages and communication of a treatment plan.
Do individual blood pressure readings count as separate units?
No. The service is reported for the 30-day monitoring period, which requires at least two readings daily; it is not reported once per reading.
What documentation supports reporting this service?
Record the monitoring period, the daily readings, the systolic and diastolic averages, and how and when the treatment plan was communicated to the patient.
Can this be used instead of remote physiologic monitoring?
It is specific to self-measured blood pressure monitoring and its 30-day reading and treatment-plan requirements. Remote physiologic monitoring codes describe a different service structure.
Does the service include communicating a treatment plan?
Yes. Communication of a treatment plan based on the reported average pressures is part of the service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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