{"ok":true,"priceId":"cms-99213","countedAsOf":"2026-09-13","tableVersion":"2026-09-09.1","figure":{"label":"Doctor's office visit, established patient, low complexity","code":"CPT 99213","publishedValueUsd":95.19,"year":"2026","basis":"allowed","basisMeaning":"allowed amount — the negotiated or fee-schedule amount","basisLabel":"allowed (the negotiated or fee-schedule amount)","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.","confidence":"DERIVED"},"publishedBy":{"agency":"CMS","agencyFullName":"Centers for Medicare & Medicaid Services","whatACorrectionHereIsAbout":"Fee schedules and outpatient payment files published by CMS. A thumb here is about a CMS-published amount.","document":"CY2026 National Physician Fee Schedule Relative Value File (RVU26C, July release, published 2026-06-30)","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"},"publicSignal":{"confirmedRight":0,"flaggedWrong":1,"n":1,"fitRatePct":0,"publicMedianBelievedUsd":185,"sample":"Self-selected members of the public using a free tool. Counts are reported exactly as entered — no weighting, no imputation, no extrapolation to a population.","medianNote":"publicMedianBelievedUsd is a demand signal about the published figure. It is never used to price a ledger."},"text":"PUBLIC CORRECTION REPORT — Waypoint Ledger\n\nPublished figure: Doctor's office visit, established patient, low complexity\nRow identifier:   cms-99213  ·  code CPT 99213\nPublished value:  $95.19 (2026)\nBasis:            allowed (the negotiated or fee-schedule amount)\nGeography:        United States, national (geographic practice cost indices set to 1.000)\nPopulation:       Medicare Part B fee-for-service beneficiaries\nPublished by:     Centers for Medicare & Medicaid Services\nSource:           CMS, CY2026 National Physician Fee Schedule Relative Value File (RVU26C, July release, published 2026-06-30)\nSource URL:       https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu26c\n\nWhat the public said about this row: 1 response — 0 say the figure describes them, 1 say it does not (0% say it fits).\nMedian amount respondents said they actually paid: $185.00 (a demand signal about the published figure; never used to price a ledger).\n\nSample: self-selected members of the public using a free tool. Counts are reported exactly as entered — no weighting, no imputation, no extrapolation to a population.\nCounted as of: 2026-09-13\nMethod and every source: https://waypoint-ledger.pages.dev/method","plainTextUrl":"https://waypoint-ledger.pages.dev/api/citation/cms-99213?format=text","methodUrl":"https://waypoint-ledger.pages.dev/method"}