Top billers · Codes · 99215

Who bills 99215?

99215 is the CPT code for: Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more. In 2024, 153,625 providers billed 99215 11,827,816 times, with an estimated $1.4B paid by Medicare.

$192.39
2026 PFS national rate (office)
153,625
Providers billing it (2024)
11,827,816
Services billed
$1.4B
Est. Medicare paid
The fee

What does Medicare pay for 99215?

Medicare's 2026 Physician Fee Schedule national rate for 99215 is $192.39 in the office setting and $125.59 in a facility. National amounts before geographic adjustment — your locality's rate differs slightly.

Office (non-facility) rate$192.39
Facility rate$125.59
Fee schedule2026 Medicare Physician Fee Schedule

What Medicare actually paid per service in 2024, on average: $120.42 (observed payment across all settings and modifiers — not a fee-schedule rate).

The list

Who bills 99215 the most.

The top 5 billers nationally, ranked by 2024 Medicare service volume.

#ProviderSpecialtyLocationServicesEst. Medicare paid
1Stuart Hetrick, D.O.NeurologyPhoenix, AZ5,220$634K
2Mark Scholz, M.D.Hematology-OncologyMarina Del Rey, CA4,514$625K
3Ian Purcell, MDNeurologySan Diego, CA4,096$597K
4Atef Rafla, M.D.AnesthesiologySanta Ana, CA4,060$626K
5Jayesh Mehta, MDHematologyChicago, IL3,534$511K

153,620 more providers billed 99215 in 2024. The full ranked list — filtered to your exact territory, with phone numbers and year-over-year history — is one search in Prospect 811.

See the full list
The breakdown

Where 99215 gets billed.

Top states by volume

California1,805,313 services
Florida769,932 services
Texas713,081 services
New York651,775 services
Pennsylvania562,548 services
Illinois540,486 services
Massachusetts527,722 services
North Carolina405,796 services

About this code

CMS descriptionEstablished patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more
Code typeCPT (Level I HCPCS)
Providers billing it (2024)153,625
Services billed (2024)11,827,816
Avg. Medicare payment per service (2024)$120.42
Where these numbers come from. Rates are CMS's own public fee-schedule files — the Physician Fee Schedule, Clinical Laboratory Fee Schedule, ASP drug pricing, DMEPOS, and the OPPS/ASC addenda — each labeled with its file year on this page; national amounts are shown before geographic adjustment. Codes with no separate rate render the fee schedule's own status in words, never a fake $0. Utilization comes from CMS's public Medicare Provider Utilization & Payment data for 2024, the most recent year released. It covers traditional Medicare fee-for-service only (no commercial insurance, no Medicare Advantage), and CMS suppresses any provider-and-code line with fewer than 11 beneficiaries before publishing, so low-volume billers don't appear at all. "Est. Medicare paid" is each billing line's average Medicare payment times its service count, summed — actual per-claim payment varies by setting and modifiers. For drug and supply codes, a "service" is a billed unit (a milligram, a milliliter, a square centimeter), not a patient visit. Code descriptions are CMS's own, from the utilization files. Prospect 811 organizes public data; it doesn't add to or alter it. Not affiliated with or endorsed by CMS. Full detail on the data page.

One code, one year, top 5. The app has all of it.

Prospect 811 answers "what is this code, what does it pay, and who bills it?" for every billable code — then filters the answer to your exact territory, with phone numbers. $79/month, no contract, 14-day refund.

Start prospecting
Sign in with Google or a magic link · or grab the free DIY guide first.