What is the top of the local market (P90) for CPT 99213 under Bcbsil for Dallas-Fort Worth-Arlington, TX providers?

The P90, the top of the local market and Reddenda's target rate, is $137.31.

How does Bcbsil's rate for CPT 99213 compare to Medicare?

The Bcbsil local median of $89.39 is 94% of Medicare's national non-facility rate of $95.19 for CPT 99213.

Reddenda · Rate Intelligence · Dallas-Fort Worth-Arlington, TX

99213 under Bcbsil, for Dallas-Fort Worth-Arlington, TX providers

Name: Bcbsil rates for CPT 99213 among Dallas-Fort Worth-Arlington, TX providers
Creator: Reddenda

Office visit, established patient, 20-29 min · Local peer median $89.39 · High confidence

$89.39 local peer median. Bcbsil's published rate file lists a local peer median of $89.39 for CPT 99213 (Office visit, established patient, 20-29 min) among 609 indexed providers in Dallas-Fort Worth-Arlington, TX. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $137.31, 54% above the median. A provider billed below this median is being paid less than peers holding the identical Bcbsil contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 609 providers · 747 rate records

P10

$61.08

P25

$71.84

Median

$89.39

P75

$100

P90 (target)

$137.31

P10$61.08

P25$71.84

Median (P50)$89.39

P75$100

P90 target$137.31

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $41.09 – $316.72

The local peer median for CPT 99213 under Bcbsil for Dallas-Fort Worth-Arlington, TX providers is $89.39, drawn from 609 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
The bottom of the local market (P10) is $61.08 and the top (P90) is $137.31; the median-to-P90 spread is $47.92.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
The lowest published rate in this market is $41.09; the highest is $316.72.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
This benchmark is drawn from 747 individual rate records that Bcbsil itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
Medicare's national non-facility rate for CPT 99213 is $95.19, making the Bcbsil local median 94% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
13.4% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

609 providers bill this code to this payer in this metro.

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These are the rates Bcbsil publishes for CPT 99213 (Office visit, established patient, 20-29 min) among Dallas-Fort Worth-Arlington, TX providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Bcbsil's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbsil to publish this rate. Page generated 2026-08-23 23:06 UTC; the live index is queried in real time on every request.