Office o/p est low 20 min
2025 Medicare reimbursement data for CPT 99213.
This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Detailed guide coming soon.
Rate data above is live and current. Full billing guide for this code is being generated.
Top denial reasons
- Modifier missing or wrong33% (3)
- Bundled into another code (NCCI edit)22% (2)
- Documentation issue22% (2)
- Frequency limit exceeded11% (1)
- Prior authorization required11% (1)
Most reported payers
- Anthem22% (2)
- UnitedHealthcare22% (2)
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