CPT 99201: New Patient Office Visit, Minor Problem
Commercial payers pay $72 on average nationally for this procedure.
CPT code 99201 is a deleted code (effective Jan. 1, 2021) that formerly described a brief evaluation and management office visit for a new patient, typically involving a problem-focused history and exam for a minor presenting problem; service type: evaluation and management (E/M) for a new patient; typical site of service: office or other outpatient setting.
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National Reimbursement Benchmarks
Across commercial payers for CPT 99201, Blue Cross Blue Shield, Cigna, and BUCA (average commercial) occupy distinct positions on the rate spectrum. Cigna posts the highest central tendency with a median of $86.10 and a mean of $93.50, while Blue Cross Blue Shield centers lower with a median of $57.50 and a mean of $62.00. BUCA sits between them as an average commercial benchmark with a mean of $72.50. These differences reflect a spread in central pricing tiers among major commercial payers rather than uniformity.
Rate dispersion measured by the interquartile range (P75 minus P25) is smallest for Blue Cross Blue Shield at $27.30 (P75 $72.90 minus P25 $45.60), indicating the tightest middle 50% of rates, while Cigna and BUCA are wider with ranges of $48.20 (Cigna P75 $115.30 minus P25 $67.10) and $31.99 (BUCA P75 $87.09 minus P25 $54.10) respectively, making Cigna the most dispersed payer among the three.