{
    "code": "99213",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99213/2018/A",
    "release_specific_url": "https://localishealth.com/cpt/99213/2018/A",
    "description": "A routine established-patient visit for a problem of low-to-moderate complexity — for example, checking in on one or two stable chronic conditions like well-controlled hypertension or diabetes, or evaluating a new minor issue such as a cough or ankle sprain. Total visit time typically runs about 20 to 29 minutes, and documentation should show the problem(s) addressed, any data reviewed (such as a lab result), and a low risk of complications from the plan of care. It is one of the most frequently billed services in all of medicine.",
    "answer": {
        "question": "How much did Medicare pay for CPT 99213 in Q1 2018?",
        "text": "Medicare paid $74.16 for CPT 99213 in the office (non-facility) setting and $52.20 in a facility under the Q1 2018 Physician Fee Schedule, effective January 2018. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.3% increase from the previous quarter."
    },
    "release": {
        "schedule": "pfs",
        "year": 2018,
        "quarter": "A",
        "label": "Q1 2018",
        "effective": "January 1 – March 31, 2018",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 74.16,
        "facility": 52.2,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 0.97,
        "practice_expense_non_facility": 1.02,
        "practice_expense_facility": 0.41,
        "malpractice": 0.07
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.9996,
    "source": {
        "label": "Physician relative value file (Q1 2018)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu18ar1.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2018/A",
        "file": "PPRRVU18_JAN.csv",
        "row": 16475,
        "sha256": "b2c0cf1c065aa6f715438573eb2251381843a90991cf56818aaf33301c43c932"
    },
    "modified_at": "2026-08-04T03:08:09+00:00"
}