CPT 99239: what Medicare pays in 2026
Visit or care management
Medicare's 2026 national amount for 99239 is $106.55 when a doctor bills it for care in a hospital, ER or surgery center.
CPT descriptions are copyrighted by the American Medical Association, so this page shows the code number only. The description printed on your bill, or the provider, will tell you what the code covers.
Medicare amounts for 99239 in 2026
- Doctor's office or clinic
- no office amount
- Doctor's bill for hospital or surgery-center care, national
- $106.55
- Hospital outpatient status B
- not recognized in the outpatient system (another code is used)
What providers charged Medicare for 99239 in 2024
From CMS's national utilization file (the most recent full year published). The charge is the provider's list price, the same kind of figure an uninsured patient is usually billed.
| Setting | Services | Average charge | Medicare allowed | Charge vs allowed |
|---|---|---|---|---|
| In an office or other non-facility setting | 10,088 | $354.68 | $107.53 | 3.3× |
| In a facility setting | 5,412,200 | $353.47 | $110.40 | 3.2× |
How Medicare builds the 99239 amount
Each physician fee schedule amount is three relative value units (RVUs), each multiplied by the locality's cost index, added up and multiplied by the 2026 conversion factor of $33.4009.
- Work RVU
- 2.15
- Practice expense RVU, facility
- 0.88
- Malpractice RVU
- 0.16