Office & outpatient visits

99213 - RVUs & Medicare payment (2026)

Office visit, established patient, level 3 (low complexity, 20-29 min).

Component	Non-facility	Facility
Work RVU	1.30	1.30
Practice expense RVU	1.46	0.33
Malpractice RVU	0.09	0.09
Total RVUs	2.85	1.72
National payment (CF $33.4009)	$95.19	$57.45
Qualifying APM payment (CF $33.5675)	$95.67	$57.74

How 99213 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99213 ranges from $86.86 in Arkansas (AR) to $120.13 in San Jose-Sunnyvale-Santa Clara (CA); calculate 99213 for your locality.

San Jose-Sunnyvale-Santa Clara (CA) $120.13 San Jose-Sunnyvale-Santa Clara (CA) $119.71 Alaska (AK) $118.72 San Francisco-Oakland-Berkeley (CA) $117.69 San Francisco-Oakland-Berkeley (CA) $117.58 Napa (CA) $111.96 Vallejo (CA) $111.81 NYC Suburbs/Long Island (NY) $109.76 National average $95.19 … 97 more localities between … Rest Of Missouri (MO) $88.38 Alabama (AL) $87.79 Mississippi (MS) $87.63 Arkansas (AR) $86.86

Non-facility payment for 99213 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - office & outpatient visits

99202 · office visit, new patient, level 2 (straightforward, 15-29 min)
99203 · office visit, new patient, level 3 (low complexity, 30-44 min)
99204 · office visit, new patient, level 4 (moderate complexity, 45-59 min)
99205 · office visit, new patient, level 5 (high complexity, 60-74 min)
99211 · office visit, established patient, level 1 (minimal, staff-level)
99212 · office visit, established patient, level 2 (straightforward, 10-19 min)
99214 · office visit, established patient, level 4 (moderate complexity, 30-39 min)
99215 · office visit, established patient, level 5 (high complexity, 40-54 min)
G2212 · medicare prolonged visit add-on, each additional 15 minutes
G2211 · medicare add-on for visit complexity in continuing, longitudinal care

Frequently asked questions

How much does Medicare pay for 99213 in 2026?

The national non-facility payment is $95.19 and the facility payment is $57.45, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 99213?

The 2026 work RVU for 99213 is 1.30. Total RVUs are 2.85 in the non-facility setting and 1.72 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.