CPT 99213 Evaluation & Management
Office visit - established patient, low complexity Cost
Body System: General
Medicare Facility Rate
$67
CMS PFS CY2026
Medicare Non-Facility Rate
$103
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.30
Work RVU
0.66
Facility PE RVU
0.11
Malpractice RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA* | $91 | $136 — $227 |
| AL — ALABAMA | $65 | $97 — $162 |
| AR — ARKANSAS | $64 | $96 — $161 |
| AZ — ARIZONA | $68 | $102 — $170 |
| AZ — Phoenix | $69 | $103 — $172 |
| CA — BAKERSFIELD | $71 | $106 — $177 |
| CA — CHICO | $70 | $105 — $176 |
| CA — EL CENTRO | $70 | $105 — $176 |
| CA — FRESNO | $70 | $105 — $176 |
| CA — HANFORD-CORCORAN | $70 | $105 — $176 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $74 | $111 — $184 |
| CA — Los Angeles | $75 | $112 — $186 |
| CA — MADERA | $70 | $105 — $176 |
| CA — MERCED | $70 | $105 — $176 |
| CA — MODESTO | $70 | $105 — $176 |
| CA — NAPA | $77 | $116 — $193 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $73 | $109 — $182 |
| CA — REDDING | $70 | $105 — $176 |
| CA — REST OF CALIFORNIA | $70 | $105 — $176 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $72 | $107 — $179 |
Frequently Asked Questions
How much does Office visit - established patient, low complexity cost?
The Medicare facility rate is $67. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Office visit - established patient, low complexity cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $67.