Internal medicine commercial reimbursement in Pennsylvania
How Pennsylvania internal medicine rates compare with the national market.
Internal medicine in Pennsylvania
What the data shows
Internal medicine ranks 23rd of 51 states in Pennsylvania with an index of 100 (100 = the specialty's national median), across 25 codes and 108 sampled providers.
Of the 25 internal medicine codes with enough data in Pennsylvania, 14 pay above the national median and 11 below; the typical code sits at 101% of the national median.
Largest premium over the national median: CPT 99457 (Rpm tx mgmt 1st 20 min) at 104%; largest discount: CPT 45385 (Colonoscopy w/lesion removal) at 92%.
Measured against Medicare, Pennsylvania internal medicine rates have a median of 113% of the Medicare rate across these codes.
Codes above and below the national median
Highest vs national
All internal medicine codes in Pennsylvania
| Code | Pennsylvania | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 99457 Rpm tx mgmt 1st 20 min | $55 | $53 | +4% | 106% | 108 | 186 | |
| CPT 93880 Extracranial bilat study | $295 | $285 | +3% | 156% | 108 | 183 | |
| CPT 99495 Transj care mgmt mod f2f 14d | $217 | $211 | +3% | 99% | 108 | 186 | |
| CPT 99348 Home/res vst est low mdm 30 | $112 | $109 | +3% | 142% | 108 | 184 | |
| CPT 78452 Ht muscle image spect mult | $637 | $621 | +3% | 149% | 108 | 183 | |
| CPT 99214 Office o/p est mod 30 min | $136 | $134 | +2% | 101% | 108 | 162 | |
| CPT 99454 Rem mntr physiol param 16-30 | $78 | $76 | +2% | 149% | 108 | 185 | |
| CPT 93306 Tte w/doppler complete | $325 | $319 | +2% | 165% | 108 | 186 | |
| CPT 99497 Advncd care plan 30 min | $110 | $108 | +1% | 127% | 108 | 180 | |
| CPT 99212 Office o/p est sf 10 min | $52 | $52 | +1% | 88% | 108 | 170 | |
| CPT 99496 Transj care mgmt high f2f 7d | $294 | $291 | +1% | 99% | 108 | 185 | |
| CPT 99490 Chrnc care mgmt staff 1st 20 | $61 | $61 | +1% | 93% | 108 | 182 | |
| CPT 99203 Office o/p new low 30 min | $126 | $125 | +1% | 107% | 108 | 173 | |
| CPT 99349 Home/res vst est mod mdm 40 | $175 | $174 | +0% | 132% | 108 | 183 | |
| CPT 96372 Ther/proph/diag inj sc/im | $24 | $24 | -0% | 156% | 108 | 185 | |
| CPT 99204 Office o/p new mod 45 min | $195 | $196 | -0% | 110% | 108 | 163 | |
| CPT 99215 Office o/p est hi 40 min | $187 | $188 | -0% | 97% | 108 | 161 | |
| CPT 99213 Office o/p est low 20 min | $92 | $92 | -1% | 96% | 108 | 168 | |
| CPT 99350 Home/res vst est high mdm 60 | $245 | $247 | -1% | 127% | 108 | 183 | |
| CPT 99487 Cplx chrnc care 1st 60 min | $118 | $121 | -3% | 82% | 108 | 177 | |
| CPT 93000 Electrocardiogram complete | $24 | $25 | -3% | 158% | 108 | 188 | |
| CPT 99205 Office o/p new hi 60 min | $246 | $256 | -4% | 104% | 108 | 166 | |
| CPT 90960 Esrd srv 4 visits p mo 20+ | $432 | $453 | -5% | 116% | 108 | 182 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $78 | $83 | -7% | 113% | 108 | 188 | |
| CPT 45385 Colonoscopy w/lesion removal | $491 | $535 | -8% | 220% | 108 | 159 |
Frequently asked questions
How do Pennsylvania internal medicine rates compare with the rest of the country?
Pennsylvania ranks 23rd of 51 states with an index of 100; 14 of 25 codes are above the national median.
Which internal medicine code has the biggest premium in Pennsylvania?
CPT 99457 (Rpm tx mgmt 1st 20 min), at 104% 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 Pennsylvania internal medicine contracts
Compare your rates with these medians.