{"ok":true,"version":"2026-09-09.1","locality":null,"localityNote":null,"localityRange":{"nationalUsd":95.19,"lowUsd":86.86,"lowLocalityKey":"AR-13","lowLocalityName":"Arkansas","highUsd":120.13,"highLocalityKey":"CA-65","highLocalityName":"San Jose-Sunnyvale-Santa Clara (San Benito County)","localityCount":109,"formula":"(work RVU x work GPCI + non-facility PE RVU x PE GPCI + MP RVU x MP GPCI) x 33.4009"},"item":{"id":"cms-99213","label":"Doctor's office visit, established patient, low complexity","synonyms":["saw my regular doctor","quick follow-up","short doctor visit","check-in with my doctor","follow-up appointment","routine visit","saw my doctor","went to the doctor","doctor visit","office visit","saw my primary care doctor","my GP","family doctor","regular appointment","follow-up with my doctor","saw my doctor again","went back to my doctor","another visit with my doctor","recheck with my doctor","med check","telehealth visit","video visit","virtual visit","video appointment with my doctor","telemedicine visit","phone visit with my doctor","nurse practitioner follow up","brief follow up appointment","my regular doctor","went to my regular doctor","went to see my regular doctor","visit with my regular doctor","went to my doctor","follow up visit","follow-up visit","doctor's appointment","appointment with my doctor","saw my internist","saw my family physician","saw my provider","saw my nurse practitioner","saw my physician assistant","primary care visit","clinic visit with my doctor","went in to see my doctor","office visit with my primary","medical appointment"],"valueUsd":95.19,"outOfPocketUsd":null,"basis":"allowed","attribution":"gross","year":"2026","geography":"United States, national (geographic practice cost indices set to 1.000)","population":"Medicare Part B fee-for-service beneficiaries","coverage":"A follow-up visit with a doctor you have seen before, for a straightforward problem. HOW THIS NUMBER WAS MADE: CMS does not publish a dollar column in the fee schedule. It publishes Relative Value Units and a conversion factor and defines the payment as their product. This figure is 2.85 Total RVUs x $33.4009 (the CY2026 conversion factor for a non-qualifying APM), at national geographic indices of 1.000. Both inputs were read in the CMS file; the multiplication is ours, so this is marked DERIVED rather than VERIFIED. You can redo it yourself. Who this describes: people on Medicare fee-for-service, that is, people 65 and older, plus people under 65 who qualified through 24 or more months of disability benefits or who have end-stage kidney disease. Who it does NOT describe: people on a plan from work, a Marketplace plan, Medicaid, or no insurance, and those usually pay more than Medicare, so read this as the floor, not your bill. Read it as a PRICE FLOOR, not as your bill: commercial insurance normally pays more than Medicare, and an uninsured person is billed the provider's charge instead, which is shown beside this figure where CMS publishes it. For scale, the average CHARGE providers submitted for this same service in 2024 was $189.25. That is what an uninsured person is billed against, and it is a different kind of number, not an addition to this one.","sourceTitle":"CMS, CY2026 National Physician Fee Schedule Relative Value File (RVU26C, July release, published 2026-06-30)","sourceUrl":"https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu26c","agency":"CMS","agencyDisplay":"CMS","confidence":"DERIVED","code":"CPT 99213","facilityUsd":57.45,"facilityComponent":"FACILITY TOTAL on the unmodified line","facilityNote":"DERIVED, same file, same conversion factor. What Medicare pays the CLINICIAN for this exact code when the care happens inside a hospital-owned clinic instead of a freestanding office: 1.72 facility total RVUs x $33.4009 = $57.45. It is lower than the office figure because the practice-expense half of the payment moves to the hospital, which bills its own facility fee on top.","hospitalFeeUsd":136.02,"hospitalFeeSource":"CMS, January 2026 Hospital Outpatient Prospective Payment System Addendum B","hospitalCopayUsd":27.21,"rules":{"summable":true,"mutuallyExclusiveWith":[],"bundlesAncillaries":false,"alternates":{"cy2024_average_submitted_charge_usd":189.25,"_charge_note":"CHARGE basis. An alternative measure of the same service, never an addition to it.","cy2024_average_allowed_usd":85.37,"_allowed_note":"What Medicare actually allowed on average in CY2024, read in the claims file. It differs from the 2026 schedule rate because many localities have cost indices below 1.000, because nurse practitioners and physician assistants are paid 85 percent of the physician rate and are inside this average, and because the two figures are two years apart. Neither is wrong.","hospital_outpatient_facility_fee_usd":136.02,"hospital_outpatient_facility_fee_source":"CMS, January 2026 Hospital Outpatient Prospective Payment System Addendum B","_opps_note":"If this happened inside a hospital-owned clinic or hospital department rather than a freestanding office, the hospital bills THIS fee in addition to the clinician's fee. Long COVID clinics are disproportionately hospital-based, so this is often the applicable path, not the exception.","hospital_outpatient_minimum_beneficiary_copay_usd":27.21,"facility_setting_physician_payment_usd":57.45,"facility_setting_total_rvu":1.72,"_facility_setting_note":"DERIVED, same file, same conversion factor. What Medicare pays the CLINICIAN for this exact code when the care happens inside a hospital-owned clinic instead of a freestanding office: 1.72 facility total RVUs x $33.4009 = $57.45. It is lower than the office figure because the practice-expense half of the payment moves to the hospital, which bills its own facility fee on top.","cy2024_source_title":"CMS, Medicare Physician & Other Practitioners - by Geography and Service, calendar year 2024 (released 2026-05)","cy2024_source_url":"https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-geography-and-service","cy2024_source_file":"MUP_PHY_R26_P05_V10_D24_Geo.csv","cy2024_source_file_url":"https://data.cms.gov/sites/default/files/2026-05/e534c74b-79b8-4892-8a95-5a17e2dfec9f/MUP_PHY_R26_P05_V10_D24_Geo.csv","cy2024_source_file_sha256":"c26956788333d03c0080017121c19e8e4d9990e9fa8ff385d7e1a2849c45074a","cy2024_source_row":"Rndrng_Prvdr_Geo_Lvl=National, HCPCS_Cd=99213, Place_Of_Srvc=O","cy2024_place_of_service":"O: provider office / non-facility setting","cy2024_retrieved":"2026-09-09","cy2024_charge_field":"Avg_Sbmtd_Chrg","cy2024_allowed_field":"Avg_Mdcr_Alowd_Amt","cy2024_total_services":64778139.1,"cy2024_rendering_providers":631995,"cy2024_method":"READ, not computed. CMS publishes one National row per HCPCS code per place of service in this file, and this figure is that row's field, rounded to the cent. Nothing is averaged, weighted or adjusted here. Open the file, filter to the row named above, and you will see the same number.","facility_setting_component":"FACILITY TOTAL on the unmodified line"}}}}