Care setting rate rollup
Retail Clinic
Evaluation, preventive, wellness, and tobacco-cessation services commonly furnished in walk-in clinics located inside retail operations.
A curated starter set for comparison—not a claim that every care setting bills every code, and not a utilization-weighted average.
At a glance
Q3 2026 compared with the prior available PFS release.
Conversion factor: 0.0%
Payable codes
10 / 10
Changed this release
0
Largest increase
None
Largest decrease
None
See the rates where you practice
Enter a ZIP code to apply that Medicare locality’s work, practice-expense, and malpractice adjustments to every row.
Current national rates
Q3 2026 releaseOffice (non-facility) amounts for professional services, GPCI 1.000, before sequestration.
| Code and service | Status | Office (non-facility) amount | Prior release | Change |
|---|---|---|---|---|
| Visits and evaluation | ||||
| 99202 New Patient Office Visit, Level 2 | Active | $75.15 | $75.15 | $0.00 · 0.0% |
| 99203 New Patient Office Visit, Level 3 | Active | $117.57 | $117.57 | $0.00 · 0.0% |
| 99204 New Patient Office Visit, Level 4 | Active | $177.36 | $177.36 | $0.00 · 0.0% |
| 99212 Established Patient Office Visit, Level 2 | Active | $59.45 | $59.45 | $0.00 · 0.0% |
| 99213 Established Patient Office Visit, Level 3 | Active | $95.19 | $95.19 | $0.00 · 0.0% |
| 99214 Established Patient Office Visit, Level 4 | Active | $135.61 | $135.61 | $0.00 · 0.0% |
| G0438 Annual Wellness Visit, Initial | Active | $174.35 | $174.35 | $0.00 · 0.0% |
| G0439 Annual Wellness Visit, Subsequent | Active | $137.61 | $137.61 | $0.00 · 0.0% |
| Treatment and ongoing management | ||||
| 99406 Smoking Cessation Counseling, Intermediate | Active | $15.36 | $15.36 | $0.00 · 0.0% |
| 99407 Smoking Cessation Counseling, Intensive | Active | $29.06 | $29.06 | $0.00 · 0.0% |
Every code links to its contracted-rate (% of Medicare) table and a full RVU breakdown, plus billing-policy context and rate history.
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How often these codes appear in Medicare
Across Original Medicare nationally in CY2024, the covered codes on this page accounted for the activity below. This is use by clinicians of all specialties—not a Retail Clinic utilization mix—and it is on a different publication cycle from the fee schedule.
Services
202.3M
Times these codes were billed
Allowed dollars
$21.3B
Across covered Medicare FFS services
Most used in this set
99214
103.7M services
Coverage: 8 of 10 displayed codes. HCPCS Level II and excluded drug codes may not appear in this utilization dataset.
Turn the list into contract math
Analyze a payer offer using these Retail Clinic codes
We’ll preload the code set in Contract Check. Add your annual volumes and ZIP to see the volume-weighted percentage of Medicare and annual-dollar difference.
Get notified when Retail Clinic rates change
Medicare updates the fee schedule every quarter. We'll email you only when a release moves one of the 10 Retail Clinic codes on this page.
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Source & method
Amounts computed from the CMS Medicare Physician Fee Schedule Q3 2026 release , GPCI 1.000, before the ~2% sequestration cut. This is our own clean-room grouping by common clinical scenario, not the AMA’s code-family taxonomy. It is a curated starter set, not a utilization-weighted specialty mix. A code with no amount is either not separately payable under the PFS or absent from the release—never a fake $0.
CMS defines a walk-in retail health clinic as place of service 17, which uses the Office (non-facility) PFS rate. The public Provider and Service utilization file cannot isolate exact POS 17 volume, so the list is curated rather than utilization weighted. Laboratory tests, vaccines, and drug products may use separate Medicare pricing systems and are not represented here.