CPT 99213 · Texas
BCBS Texas 99213 rate: what practices are paid.
Blue Cross and Blue Shield of Texas publishes the rate it negotiated with each practice, every month, by NPI. In its September 2026 files, the middle rate for 99213 (office visit, established patient, 20–29 min) was $61.95, and half of provider groups fell between $44.25 and $69.03. Yours may differ.
BCBS Texas contracts with practices in Texas. These figures are across the provider groups in its own files.
The payer’s published negotiated rate for your NPI, for the six codes your specialty bills most. For a primary care practice:
| Code | Visit | Negotiated rate |
|---|---|---|
| 99213 | Office visit, established patient, 20–29 min | — |
| 99214 | Office visit, established patient, 30–39 min | — |
| 99215 | Office visit, established patient, 40–54 min | — |
| 99203 | Office visit, new patient, 30–44 min | — |
| 99204 | Office visit, new patient, 45–59 min | — |
| 99212 | Office visit, established patient, 10–19 min | — |
Every figure comes from the payer’s own file, with the network and file date it was published under. We never invent a benchmark.
From BCBS Texas’s September 2026 files
99213: office visit, 20–29 min.
The rate in the middle of the provider groups that carry one rate for 99213.
Half of the provider groups are paid between $44.25 and $69.03; a quarter below, a quarter above.
A group in two networks counts once in each.
Last checked against BCBS Texas’s postings Sep 21, 2026.
36,879 more provider groups carry more than one rate for 99213 in the same file and are left out rather than averaged. Source: Blue Cross and Blue Shield of Texas’s in-network rate files under the federal Transparency in Coverage rule, September 2026.
How the rate is chosen
The same rule as your own lookup.
For each provider group we take the in-office rate (place of service 11, or a rate published for any setting), professional billing only, and the plain code before any modifier. A group whose file lists several different rates for the code isn’t averaged in. 99213 is billed mostly by primary care and specialist offices. How we pick a rate, code by code →
99213 at other payers
The same code, payer by payer.
| Payer | Middle rate | Middle half | Files |
|---|---|---|---|
| UnitedHealthcare | $78.43 | $65.06 – $101.37 | September 2026, nationwide |
| Aetna | $76.71 | $57.59 – $106.00 | September 2026, nationwide |
| Cigna | $91.00 | $68.57 – $125.08 | September 2026, nationwide |
| BCBS Texas | $61.95 | $44.25 – $69.03 | September 2026 |
| Florida Blue | $68.78 | $66.19 – $78.60 | September 2026 |
| Horizon BCBS New Jersey | $73.17 | $73.17 – $83.93 | September 2026 |
| BCBS Mississippi | $92.08 | $81.00 – $92.08 | September 2026 |
In these files, BCBS Texas’s middle rate for 99213 is the lowest of the 7 payers here (highest: BCBS Mississippi, $92.08). It is $24.46 more than BCBS Texas’s middle rate for 99212 ($37.49).
Payers with a monthly read of their files. At our other payers a lookup reads your own rate straight from the file, so there’s no typical figure to compare.
Other codes at BCBS Texas
BCBS Texas’s everyday codes, September 2026.
| Code | Visit | Middle rate | Middle half |
|---|---|---|---|
| 99212 | Office visit, established patient, 10–19 min | $37.49 | $29.02 – $42.22 |
| 99213 | Office visit, established patient, 20–29 min | $61.95 | $44.25 – $69.03 |
| 99214 | Office visit, established patient, 30–39 min | $90.75 | $64.83 – $100.87 |
| 99215 | Office visit, established patient, 40–54 min | $121.18 | $86.57 – $135.04 |
| 99203 | Office visit, new patient, 30–44 min | $91.21 | $65.41 – $91.56 |
| 99204 | Office visit, new patient, 45–59 min | $136.65 | $98.02 – $137.21 |
| 90791 | Psychiatric diagnostic evaluation | $140.20 | $112.00 – $150.57 |
| 90834 | Psychotherapy, 45 min | $87.49 | $62.50 – $93.96 |
| 90837 | Psychotherapy, 60 min | $129.60 | $104.75 – $139.19 |
Your own rate
Is BCBS Texas paying you this?
The figure that matters is the one BCBS Texas published for your practice. Look up your own BCBS Texas rates free: your NPI, the codes your specialty bills most, by email. On a paid plan, BCBS Texas sits next to your other payers for the codes you bill, and the underpayment check shows any code allowed below it.
Questions
About BCBS Texas’s 99213 rate.
How much does BCBS Texas pay for CPT 99213?
In BCBS Texas’s September 2026 files, the middle in-office rate for 99213 (Office visit, established patient, 20–29 min) was $61.95, and half of the provider groups were paid between $44.25 and $69.03. Your own contract can sit anywhere in or outside that range.
Where does this number come from?
From Blue Cross and Blue Shield of Texas’s own in-network rate files, published under the federal Transparency in Coverage rule. These figures are from its September 2026 files (36 files). We take each provider group’s rate for 99213 by the same rule a lookup uses and report the middle and the middle half. Nothing is estimated.
Why is my rate different?
BCBS Texas negotiates with each practice separately, so contracts differ. The network matters too (one practice can hold different rates in different BCBS Texas products), and so do setting and modifiers. These figures are in-office, professional rates for the plain code.
How do I find my own BCBS Texas rate for 99213?
Enter your NPI in the free lookup on this page. It reads BCBS Texas’s file for the rate published for your practice, for the codes your specialty bills most, and emails you a copy.