CPT 99213: Established Patient Office/Outpatient Visit, Low Complexity
Medicare pays $98 and commercial payers pay $110 on average nationally for this procedure.
CPT code 99213 describes an office or other outpatient evaluation and management visit for an established patient involving a low level of medical decision making or 20 or more minutes of total provider time on a single date; typical service type is an established patient office/outpatient visit, and the usual site of service is an office or outpatient clinic where evaluation, brief problem-focused history and exam, and straightforward management occur.
For related coverage guidance, see recent payer policy updates: Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Service Center (ASC) Select.
Customize your policy alerts
Sign up for cpt 99213 policy alerts
Get alerted when payer policies referencing 99213 are released or updated.
Monitor payer policy activity
National Reimbursement Benchmarks
Medicare’s mean rate for CPT 99213 sits at $98.3, virtually aligned with BUCA’s average commercial mean of $110.1, indicating commercial contracts on average pay modestly above Medicare for this code. The proximity of those means suggests limited divergence between a representative commercial benchmark and Medicare reimbursement for outpatient established visit level 3.
Dispersion (P75 minus P25) highlights where commercial variability concentrates: Blue Cross Blue Shield shows a spread of $59.0 ($142.4 - $82.5), UnitedHealth Group a spread of $60.6 ($127.4 - $67.8), Cigna a spread of $60.3 ($120.9 - $57.6), BUCA a spread of $59.7 ($133.9 - $74.2), and Aetna the tightest at $52.5 ($119.2 - $64.5). These ranges reflect relatively comparable variability across major payers, with Aetna exhibiting the narrowest P25–P75 window and UnitedHealth Group the widest.