Internal medicine commercial reimbursement in Massachusetts
How Massachusetts internal medicine rates compare with the national market.
Internal medicine in Massachusetts
What the data shows
Internal medicine ranks 7th of 51 states in Massachusetts with an index of 135 (100 = the specialty's national median), across 25 codes and 121 sampled providers.
Of the 25 internal medicine codes with enough data in Massachusetts, 25 pay above the national median and 0 below; the typical code sits at 135% of the national median.
Largest premium over the national median: CPT 99490 (Chrnc care mgmt staff 1st 20) at 159%; largest discount: CPT 78452 (Ht muscle image spect mult) at 114%.
Measured against Medicare, Massachusetts internal medicine rates have a median of 150% of the Medicare rate across these codes.
Codes above and below the national median
Highest vs national
All internal medicine codes in Massachusetts
| Code | Massachusett | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 99490 Chrnc care mgmt staff 1st 20 | $97 | $61 | +59% | 147% | 118 | 187 | |
| CPT 90960 Esrd srv 4 visits p mo 20+ | $699 | $453 | +55% | 188% | 118 | 185 | |
| CPT 93880 Extracranial bilat study | $423 | $285 | +48% | 224% | 120 | 188 | |
| CPT 99487 Cplx chrnc care 1st 60 min | $178 | $121 | +46% | 123% | 118 | 177 | |
| CPT 99215 Office o/p est hi 40 min | $269 | $188 | +43% | 140% | 121 | 202 | |
| CPT 99214 Office o/p est mod 30 min | $190 | $134 | +42% | 140% | 121 | 202 | |
| CPT 93306 Tte w/doppler complete | $449 | $319 | +41% | 228% | 120 | 187 | |
| CPT 99213 Office o/p est low 20 min | $129 | $92 | +40% | 136% | 121 | 202 | |
| CPT 99205 Office o/p new hi 60 min | $356 | $256 | +39% | 150% | 121 | 203 | |
| CPT 99348 Home/res vst est low mdm 30 | $151 | $109 | +39% | 191% | 118 | 175 | |
| CPT 99350 Home/res vst est high mdm 60 | $341 | $247 | +38% | 177% | 118 | 176 | |
| CPT 99349 Home/res vst est mod mdm 40 | $239 | $174 | +37% | 180% | 118 | 176 | |
| CPT 99203 Office o/p new low 30 min | $169 | $125 | +35% | 144% | 121 | 202 | |
| CPT 99204 Office o/p new mod 45 min | $263 | $196 | +34% | 148% | 121 | 203 | |
| CPT 99212 Office o/p est sf 10 min | $69 | $52 | +33% | 116% | 121 | 202 | |
| CPT 99454 Rem mntr physiol param 16-30 | $100 | $76 | +31% | 191% | 119 | 190 | |
| CPT 99497 Advncd care plan 30 min | $140 | $108 | +30% | 162% | 121 | 198 | |
| CPT 99495 Transj care mgmt mod f2f 14d | $273 | $211 | +29% | 124% | 121 | 193 | |
| CPT 99496 Transj care mgmt high f2f 7d | $373 | $291 | +28% | 125% | 120 | 197 | |
| CPT 93000 Electrocardiogram complete | $32 | $25 | +27% | 207% | 121 | 197 | |
| CPT 96372 Ther/proph/diag inj sc/im | $30 | $24 | +24% | 194% | 121 | 202 | |
| CPT 99457 Rpm tx mgmt 1st 20 min | $65 | $53 | +22% | 125% | 119 | 190 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $100 | $83 | +20% | 145% | 120 | 183 | |
| CPT 45385 Colonoscopy w/lesion removal | $640 | $535 | +20% | 286% | 119 | 182 | |
| CPT 78452 Ht muscle image spect mult | $706 | $621 | +14% | 165% | 116 | 119 |
Frequently asked questions
How do Massachusetts internal medicine rates compare with the rest of the country?
Massachusetts ranks 7th of 51 states with an index of 135; 25 of 25 codes are above the national median.
Which internal medicine code has the biggest premium in Massachusetts?
CPT 99490 (Chrnc care mgmt staff 1st 20), at 159% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Massachusetts internal medicine contracts
Compare your rates with these medians.