# 99214 Reimbursement Rate 2026: What Payers Publish

> The middle published rate and middle half for CPT 99214 at seven payers, from their September 2026 Transparency in Coverage files, what moves an individual practice’s rate, and how to check your own.

- Published: 2026-10-10
- Author: RateBench
- Human page: https://ratebench.health/blog/99214-reimbursement-rate-2026
- This document: https://ratebench.health/blog/99214-reimbursement-rate-2026.md
- Product (sign up / app): https://app.ratebench.health

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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.

| Payer | Middle rate | Middle half (25th–75th percentile) |
|---|---|---|
| [Cigna](/rates/cigna/99214) | $131.54 | $102.07–$179.60 |
| [BCBS Mississippi](/rates/bcbsms/99214) | $130.62 | $115.00–$130.62 |
| [Aetna](/rates/aetna/99214) | $119.54 | $89.71–$166.75 |
| [UnitedHealthcare](/rates/uhc/99214) | $115.27 | $96.15–$147.69 |
| [Horizon BCBS New Jersey](/rates/horizon/99214) | $107.66 | $107.66–$123.49 |
| [Florida Blue](/rates/floridablue/99214) | $98.18 | $94.51–$112.20 |
| [BCBS Texas](/rates/bcbstx/99214) | $90.75 | $64.83–$100.87 |

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](/blog/allowed-amount-vs-paid-amount)
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](/blog/office-visit-rates-by-payer-2026). For the other
codes we publish typical rates for, see the [codes page](/codes).

## How to check your own 99214 rate

1. Open your payer's page from the table above, or from the [payer list](/payers).
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](/features/underpayments)
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.

## Common questions

### What do commercial payers pay for 99214 in 2026?

Across seven payers’ September 2026 published files, the middle negotiated rate for 99214 ranged from $90.75 at BCBS Texas to $131.54 at Cigna. Your own rate depends on your contract, and the free lookup returns the rate your payer published for your NPI.

### Does Medicare pay the same for 99214?

No. Medicare sets 99214 in its Physician Fee Schedule, adjusted by location; you can search it on CMS.gov. These figures are commercial negotiated rates.

### Why is my 99214 rate lower than these figures?

These are middle rates across many provider groups, so half sit below the middle by definition. A rate near the bottom of a payer’s range can be worth raising at renewal.

### How often do payers change these rates?

Payers republish their files monthly, and individual rates can change without notice.

## Sources

1. Federal Register / U.S. Departments of the Treasury, Labor and HHS (November 12, 2020). "Transparency in Coverage, final rules (85 FR 72158)". https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage
2. CMS (accessed October 2026). "price-transparency-guide: technical implementation guide and in-network rates schema". https://github.com/CMSgov/price-transparency-guide
3. CMS (accessed October 2026). "Physician Fee Schedule look-up tool". https://www.cms.gov/medicare/physician-fee-schedule/search
4. RateBench (generated September 23, 2026). "Typical-rates snapshot from seven payers’ September 2026 in-network files". https://ratebench.health/payers