99214 Reimbursement Rate 2026: What Payers Publish

99214 is an established-patient office visit of 30–39 minutes, or one with moderate medical decision making. For many primary care practices it's the most billed visit code, so what a payer pays for it matters more than almost any other single rate.

Payers now publish their negotiated rates under the federal Transparency in Coverage rules, so we can answer from their own files rather than surveys.

What seven payers publish for 99214

These are the middle published rates for 99214 in each payer's September 2026 in-network files, across the provider groups that carry a single rate for it.

Source: each payer's in-network rate files, September 2026, as read by RateBench (snapshot of 23 September 2026). Middle rate is the median of published rates. These are typical rates, not any one practice's rate. Each payer name links to its 99214 page, with the provider groups counted and the files read.

How to read these numbers

The spread within a payer matters more than the gap between payers. At Aetna, a practice in the bottom quarter is paid under $89.71 for 99214, and one in the top quarter over $166.75: nearly twice as much for the same visit from the same payer.

Regional Blues cluster tightly. Florida Blue's middle half spans under $18. The national payers' ranges are wider because their files cover practices across the country.

Some figures need care. BCBS Mississippi's comes from a single published file, so its range is narrow; treat it as indicative. At Aetna, most provider groups list more than one rate for 99214 and are left out rather than averaged, so its figures describe the groups with a single rate.

Why your 99214 rate may differ

• Your contract. Rates are negotiated practice by practice, often as a percentage of a payer's standard schedule.
• Network and plan type. The same payer may pay differently across its commercial networks.
• Place of service. Office and facility rates for the same code can differ.
• Provider type. Some contracts set different rates by specialty or credential.

What you're actually paid isn't always the contracted rate either. Our guide to allowed amount vs paid amount vs contracted rate explains the difference.

99213 and 99215 for context

The same files give the neighbouring visit levels. For 99213, 99214 and 99215 side by side at all seven payers, see Same code, different pay. For the other codes we publish typical rates for, see the codes page.

How to check your own 99214 rate

1. Open your payer's page from the table above, or from the payer list.
2. Enter your billing NPI and email in the free lookup.
3. We send the rate the payer published for your NPI, for 99214 and five other codes your specialty bills most, with the file month and source.

Then compare it with the allowed amounts on your remittances. If a payer allows less than its published rate, the underpayment check flags each code, worst gap first.

What a small gap costs

Say a payer allows $8 less than your published rate for 99214 and you see 15 of those visits a month. That's $120 a month, or $1,440 a year, from one code at one payer. Your numbers will differ, which is why it's worth checking.