CPT 99213 is a low-level established patient office or outpatient E/M code. In the imported 2026 CMS RVU data set used by RVUinUSA, 99213 carries 1.30 work RVU, 1.46 non-facility practice expense RVU, 0.33 facility practice expense RVU, and 0.09 malpractice RVU before GPCI and conversion factor assumptions. It is a high-volume reference code for primary care, internal medicine, pediatrics, and specialty follow-up visits where payment, productivity, and coding boundaries need to stay separate. This page explains the RVU and payment effect after 99213 is supported by documentation and payer rules; it is not coding advice and does not determine whether a specific visit should be coded as 99213.
99213 in the 2026 RVU data set
The imported 2026 descriptor for 99213 is a low-level established patient office or outpatient visit with a 20-minute reference descriptor. For RVU modeling, the core components are 1.30 work RVU, 1.46 non-facility practice expense RVU, 0.33 facility practice expense RVU, and 0.09 malpractice RVU. These values support payment estimates, productivity analysis, and contract review only after the E/M level is independently supported. They do not replace documentation, medical decision making or time rules, payer policy, or compliance review.
- Work RVU: 1.30.
- Non-facility PE RVU: 1.46; facility PE RVU: 0.33.
- Malpractice RVU: 0.09.
CPT 99213 2026 RVU components
Values from the imported 2026 CMS RVU data set used by RVUinUSA. Payment estimates require setting, locality, and conversion factor assumptions.
RVU values describe financial and productivity inputs after code selection. They are not coding advice.
How this connects to RVU payment
GPCI is applied component by component. A locality comparison is only meaningful when the CPT code, setting, and participant status stay fixed.
- Code input
- CPT/HCPCS
- Setting input
- Facility or office
- Output
- Adjusted total RVU
National total RVU and payment estimate
At national GPCI values, 99213 has a non-facility total RVU of 2.85 and a facility total RVU of 1.72. Using the 2026 non-QPP conversion factor of $33.4009, that produces an estimated national non-facility Medicare payment of about $95.19 and an estimated national facility payment of about $57.45. The difference is driven by practice expense RVU because the physician work RVU and malpractice RVU stay the same across settings. A professional estimate should preserve the CPT code, site of service, locality, data year, and participant status beside the payment result.
- National non-facility total RVU: 2.85; non-QPP estimate about $95.19.
- National facility total RVU: 1.72; non-QPP estimate about $57.45.
- QPP/APM status changes the final multiplier, not the CPT RVU components.
National 99213 payment model
Use 1.46 PE RVU for non-facility estimates and 0.33 PE RVU for facility estimates before locality GPCI adjustment.
Compare 99213 with adjacent established patient codes
99213 is commonly compared with 99212, 99214, and 99215 because they sit in the same established patient office or outpatient E/M family. That comparison can clarify the payment and productivity spread across visit levels, but it should not be used to choose a code. Under national non-facility assumptions, 99212 totals 1.78 RVU, 99213 totals 2.85 RVU, 99214 totals 4.06 RVU, and 99215 totals 5.76 RVU. RVUinUSA shows the economics once the coding basis is established.
- 99212: 0.70 work RVU and 1.78 national non-facility total RVU.
- 99213: 1.30 work RVU and 2.85 national non-facility total RVU.
- 99214: 1.92 work RVU and 4.06 national non-facility total RVU.
Established patient E/M comparison
National non-facility comparison using imported 2026 RVU components before locality adjustment.
The table is an RVU comparison. It does not determine the correct E/M level for a specific patient encounter.
Keep the 99213 and 99214 boundary explicit
The RVU spread between 99213 and 99214 is large enough to matter in payment, productivity, and compensation review. In the 2026 RVU data, 99214 carries 0.62 more work RVU than 99213 and about $40.42 more national non-facility non-QPP payment. That does not mean a visit should be moved from 99213 to 99214 for financial reasons. The patient's clinical situation, applicable E/M rules, documentation, payer policy, time or medical decision making requirements, modifiers, and compliance review control code selection before RVU impact is reviewed.
- 99214 carries 0.62 more work RVU than 99213 in the imported 2026 data.
- The national non-facility non-QPP payment spread is about $40.42.
- RVU difference explains economics after code support; it is not a coding instruction.
Use 99213 carefully in productivity and contract review
For physician compensation, 99213 contributes 1.30 work RVU when the employment agreement credits the service. Because 99213 can be high volume, small changes in code mix can materially affect annual productivity, panel economics, and threshold modeling. The compensation effect depends on legitimate visit volume, schedule design, patient complexity, dollars-per-wRVU rate, threshold, excluded services, modifier handling, and whether the plan uses the same CMS RVU schedule as the estimate. Medicare payment uses total RVU, GPCI, and conversion factor assumptions; employment compensation usually uses credited work RVU and written contract rules.
- Use 1.30 wRVU for productivity modeling only when the contract credits 99213.
- Separate Medicare payment estimates from employment compensation calculations.
- Review whether the contract freezes RVU values to a specific CMS schedule year.
Run 99213 through RVUinUSA tools
The practical workflow is to open the 99213 CPT page, confirm the imported 2026 RVU components, run the RVU calculator with the correct setting and GPCI locality, and compare adjacent established patient codes only under the same assumptions. If the question is productivity or compensation, use the salary estimator or contract analyzer after the code mix and credited wRVU rules are known. If the question is payment, keep locality, setting, QPP status, and conversion factor visible with the result.
- Use /cpt/99213 for code-level RVU components.
- Use the RVU calculator for same-assumption payment estimates.
- Use the 99213 vs 99214 article for focused adjacent-code interpretation.
99213 RVU workflow
Move from code-level RVU lookup to payment, locality, adjacent-code comparison, and contract interpretation.