# CPT 99213

> Medicare paid $74.16 for CPT 99213 in the office (non-facility) setting and $52.20 in a facility under the Q3 2018 Physician Fee Schedule, effective July 2018. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2018, when it increased 0.3%.

## What it is

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.

## Selected release

- Release: Q3 2018 (2018 C)
- Effective: July 1 – September 30, 2018
- Status indicator: A
- Office (non-facility) national allowed amount: $74.16
- Facility national allowed amount: $52.20
- Sequestration: not applied

## RVUs and formula

- Work RVU: 0.97
- Office (non-facility) practice expense RVU: 1.02
- Facility practice expense RVU: 0.41
- Malpractice RVU: 0.07
- Conversion factor: 35.9996
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q3 2018)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu18c1.zip
- Parsed file: PPRRVU18_JUL.csv, row 16,505
- Canonical page: https://localishealth.com/cpt/99213/2018/A
- Release-specific citation URL: https://localishealth.com/cpt/99213/2018/C
- Last significant update: 2026-08-04T03:08:27+00:00