99214's 2026 national Medicare rate: $115.27 for nurse practitioners
Look up your locality's rate in Medicare's look-up tool, and set your 99214 charge at or above that rate and each payer's contracted rate.
Head of Growth and Operations, JotPsych
You bill a 99214 for most medication management visits. You're updating your 2026 charge. The national physician rate in Medicare's 2026 fee schedule is $135.61.
Check your charge. Medicare bases its payment on the lesser of your 99214 charge and your local rate, so a charge below your local rate lowers what you're paid.
Medicare's 2026 fee schedule sets the national physician rate, and 42 U.S.C. 1395l(a)(1)(O) sets the nurse practitioner rate at 85% of the physician rate. Medicare adjusts each national rate for your payment locality.
What a 99214 needs
To bill a 99214, you need moderate medical decision making (MDM) or 30 minutes of your time on the date of the visit. MDM rates three elements: the problems, the data, and the risk. Two at moderate support a 99214.
Two stable chronic illnesses, each with a prescription you manage, put the problems and the risk at moderate.
Time is the other way to a 99214. Medicare counts the time you spend reviewing tests, ordering medications, documenting, and coordinating care, so write your start and stop times or your total time in the note. Work you bill separately, such as psychotherapy with an add-on code, doesn't count.
Commercial payer averages
PayerPrice's national averages for a 99214 run from 88% of Medicare's national physician rate at Aetna to 107% at Cigna.
Only Cigna's average tops Medicare's national physician rate of $135.61. The spread from Aetna to Cigna is $25.28 for the same visit.
Three checks for your charge
- Look up your locality's physician rate in Medicare's Physician Fee Schedule look-up tool. Take 85% of that rate when you bill as a nurse practitioner.
- Compare your 99214 charge with that local rate and with each payer's contracted rate, and set the charge at or above the highest one.
- Read each payer contract for how the payer pays a charge below the contracted rate.
Your fee schedule keeps each payer's contracted rate by code, and JotPsych flags a 99214 billed below that rate.
Book 15 minutes- Centers for Medicare & Medicaid Services, PFS Relative Value Files: 2026 national physician rates and short descriptors (such as "Office o/p est mod 30 min") from the October 2026 release (RVU26D), file PPRRVU2026_Oct_nonQPP, conversion factor 33.4009.
- Legal Information Institute, Cornell Law School, 42 U.S.C. 1395l(a)(1)(N) and (O): Medicare pays 80 percent of the lesser of the actual charge and the fee schedule amount for a physician's service, and 80 percent of "the lesser of the actual charge or 85 percent of the fee schedule amount" for a nurse practitioner's, read October 2, 2026.
- American Medical Association, CPT evaluation and management office visit revisions, Table 1: Levels of Medical Decision Making, effective January 1, 2021.
- Centers for Medicare & Medicaid Services, Medicare Learning Network, Evaluation and Management Services (MLN006764), May 2026.
- PayerPrice, CPT 99214 fee schedule by payer, national averages by payer, last verified October 2026; the page names no clinician type.
- Centers for Medicare & Medicaid Services, Physician Fee Schedule look-up tool, read October 1, 2026.