Established patient office visit: how much does Medicare pay?

Nationally, the Q3 2026 Physician Fee Schedule pays $95.19 in an office (non-facility) setting and $57.45 in a facility setting for 99213. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.

Procedure · Updated Aug 1, 2026

Established patient office visit: CPT code and Medicare rate

A routine visit with a clinician you have seen before. Level 3 (99213) is the most common office visit billed to Medicare, covering follow-up of one or two stable conditions or a new but minor problem.

Also called: office visit established patient, sick visit, follow-up visit, regular office visit, check-up with my doctor.

Usually billed as

99213 Established Patient Office Visit, Level 3

Office (non-facility): $95.19
Facility: $57.45

National amounts for the Q3 2026 release (July 1 – September 30, 2026), using geographic index values of 1.000. Your local rate differs — open the code page for the locality breakdown.

Established-patient levels run 99212 through 99215. A visit for a new problem, or one where medication is being changed, often supports 99214 instead.

Related codes

Codes worth checking before you settle on 99213.

Code	What it covers	Office	Facility
99212	Established Patient Office Visit, Level 2	$59.45	$31.06
99214	Established Patient Office Visit, Level 4	$135.61	$84.50
99215	Established Patient Office Visit, Level 5	$192.39	$125.59

A dash means the code has no national amount in this release — it may be carrier-priced, bundled, or not separately payable. That is never the same as $0.

Common questions

Established patient office visit: which code is it?: 99213 — Established Patient Office Visit, Level 3. A routine visit with a clinician you have seen before. Level 3 (99213) is the most common office visit billed to Medicare, covering follow-up of one or two stable conditions or a new but minor problem.
Established patient office visit: how much does Medicare pay?: Nationally, the Q3 2026 Physician Fee Schedule pays $95.19 in an office (non-facility) setting and $57.45 in a facility setting for 99213. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.
Established patient office visit: what else affects the billing?: Established-patient levels run 99212 through 99215. A visit for a new problem, or one where medication is being changed, often supports 99214 instead.

Need the rate where you practice?

Every code page carries the full locality breakdown, the RVU and GPCI inputs, and the release that answered.

Open the code page

Keep exploring

All procedures How Medicare pays Office vs. facility rates Check a medical bill

This page maps everyday language to the code a claim normally carries. It is general information about how Medicare prices a service, not coding advice for a specific claim — the correct code always depends on what was actually documented and performed.

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