CPT 99454: what Medicare pays in 2026
Visit or care management
Medicare's 2026 national amount for 99454 is $52.11 when a doctor's office or clinic bills it. Across Medicare's 109 payment localities the office amount runs from $44.64 in Arkansas to $74.83 in San Jose-Sunnyvale-Santa Clara (San Benito County), CA.
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 99454 in 2026
- Doctor's office or clinic, national
- $52.11
- Hospital outpatient rate, national (APC 5741)
- $38.13
- Hospital outpatient status Q1
- packaged when billed with a separately paid procedure or visit, otherwise paid
Hospital outpatient rates are national figures before Medicare's wage adjustment, which moves about 60% of the rate up or down with local hospital wages.
What providers charged Medicare for 99454 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 | 2,155,063 | $129.75 | $47.80 | 2.7× |
| In a facility setting | 17,068 | $172.51 | $47.90 | 3.6× |
How Medicare builds the 99454 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
- 0.00
- Practice expense RVU, office
- 1.55
- Malpractice RVU
- 0.01
99454 in every Medicare locality
The office amount is lowest in Arkansas and highest in San Jose-Sunnyvale-Santa Clara (San Benito County), CA.