Care setting rate rollup

Retail Clinic

Evaluation, preventive, wellness, and tobacco-cessation services commonly furnished in walk-in clinics located inside retail operations.

This is a curated starter set for comparison. It doesn't claim that every care setting bills every code, and it isn't a utilization-weighted average.

At a glance

Q3 2017 compared with the prior available PFS release.

Conversion factor: 0.0% no change

Payable codes

10 / 10

Changed this release

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 Copy link

Q3 2017 release

Office (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	$75.73	$75.73	$0.00 · 0.0% no change
99203 New Patient Office Visit	Active	$109.46	$109.46	$0.00 · 0.0% no change
99204 Long New Patient Office Visit	Active	$166.16	$166.16	$0.00 · 0.0% no change
99212 Brief Follow-Up Office Visit	Active	$44.14	$44.14	$0.00 · 0.0% no change
99213 Routine Follow-Up Office Visit	Active	$73.93	$73.93	$0.00 · 0.0% no change
99214 Long Follow-Up Office Visit	Active	$108.74	$108.74	$0.00 · 0.0% no change
G0438	Active	$173.70	$173.70	$0.00 · 0.0% no change
G0439	Active	$117.71	$117.71	$0.00 · 0.0% no change
Treatment and ongoing management
99406	Active	$14.71	$14.71	$0.00 · 0.0% no change
99407	Active	$28.35	$28.35	$0.00 · 0.0% no change

Every code links to its contracted-rate (% of Medicare) table and a full RVU breakdown, plus billing-policy context and rate history.

How often these codes appear in Medicare Copy link

Across Original Medicare nationally in CY2024, the covered codes on this page accounted for the activity below. It counts use by clinicians of every specialty, not just Retail Clinic, and CMS publishes it on a different 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.

Open in Contract Check

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 Copy link

Amounts are computed from the CMS Medicare Physician Fee Schedule Q3 2017 release, GPCI 1.000, before the ~2% sequestration cut. The grouping by common clinical scenario is our own, not the AMA’s code-family taxonomy, and it’s 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. It never means $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.