99213
Office/outpatient visit, est. patient, low-mod complexity
Office/outpatient visit, est. patient, low-mod complexity is the #4 most-billed Medicaid procedure code, with $33.00B in payments across 764.3M claims from 2018–2024. The national median cost per claim is $37.81.
Total Paid
$33.00B
3.02% of all spending
Total Claims
764.3M
Providers
164K
Avg Cost/Claim
$43
National Cost Distribution
How much do providers bill per claim for 99213? Based on 157K providers billing this code nationally.
Median
$37.81
Average
$42.21
Std Dev
$44.22
Max
$8,083.73
Percentile Distribution (Cost per Claim)
50% of providers bill between $23.77 and $53.69 per claim for this code.
90% bill between $10.04 and $71.00.
Top 1% bill above $151.86.
About This Procedure
HCPCS code 99213 (Office/outpatient visit, est. patient, low-mod complexity) was billed by 164K providers across 764.3M claims, totaling $33.00B in Medicaid payments from 2018–2024. This code was used for 639.4M unique beneficiaries.
Investigation Context
Office visit for an established patient with low complexity (99213) is one of the most commonly billed codes in all of healthcare. It represents a standard follow-up visit and is used millions of times annually across Medicaid. Due to its volume, even small per-claim anomalies can represent significant spending.
Risk Assessment
This procedure is featured in our investigation: Impossible Volume
Read the full analysis for context on billing patterns associated with this code.
Billing Statistics
Median Cost/Claim
$37.81
Providers Billing
157K
National Spending
$33.00B
Avg/Median Ratio
1.12×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99213
| # | Provider | Total Paid |
|---|---|---|
| 1 | City Medical Of Upper East Side Pllc New York, NY · Clinic/Center Urgent Care | $226.5M |
| 2 | Nationwide Children's Hospital Columbus, OH · General Acute Care Hospital | $154.8M |
| 3 | Children's Hospital Medical Center Of Akron Akron, OH · General Acute Care Hospital Children | $147.0M |
| 4 | Sun River Health Inc. Peekskill, NY · Clinic/Center Federally Qualified Health Center (FQHC) | $140.9M |
| 5 | Winslow Indian Health Care Center Inc Winslow, AZ · Clinic/Center Public Health Federal | $120.8M |
| 6 | Southcentral Foundation Anchorage, AK · Clinic/Center Community Health | $99.6M |
| 7 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $91.4M |
| 8 | The New York And Presbyterian Hospital New York, NY · General Acute Care Hospital | $65.1M |
| 9 | Bronxcare Health System Bronx, NY · General Acute Care Hospital | $64.7M |
| 10 | Children's Hospital Medical Center Cincinnati, OH · Clinic/Center, Primary Care | $61.8M |
| 11 | Montefiore Medical Center Bronx, NY · Anesthesiology | $60.3M |
| 12 | 1063436624 | $59.4M |
| 13 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $57.4M |
| 14 | University Of Texas Medical Branch At Galveston Galveston, TX · Clinic/Center, Ambulatory Surgical | $56.0M |
| 15 | Optum Medical Care Of New Jersey Pc Secaucus, NJ · Durable Medical Equipment & Medical Supplies | $54.1M |
| 16 | Medical Associates Of Ebnhc East Boston, MA · Clinic/Center, Community Health | $52.9M |
| 17 | Yukon-kuskokwim Health Corporation Bethel, AK · Physician Assistant | $51.2M |
| 18 | Mid Atlantic Pemanente Medical Group Rockville, MD · Health Maintenance Organization | $50.8M |
| 19 | Rector & Visitors Of The University Of Virginia Charlottesville, VA · General Acute Care Hospital | $50.7M |
| 20 | Tanana Chiefs Conference Fairbanks, AK · Clinic/Center Multi-Specialty | $50.0M |
Showing top 20 of 164K providers billing this code