New Reveon Health Study Finds 33% Gap in 99213 Rates by Provider Group Size

Analysis of January 2026 Transparency in Coverage data across United Healthcare, Aetna and Cigna found that median negotiated rates for CPT 99213 were approximately 33% higher in the 1,000-2,999 provider bin than in the 1-9 provider bin, while variability remained high across payers, regions and states.

ALPHARETTA, Ga., April 7, 2026 /PRNewswire/ -- Reveon Health today published a new case study analyzing January 2026 Transparency in Coverage (TiC) data and finding that, for the common office visit code CPT 99213, median negotiated commercial rates were approximately 33% higher in the 1,000-2,999 provider-group bin than in the 1-9 provider-group bin. The analysis drew from more than 400 GB of raw TiC machine-readable files, more than 99,000 provider group/rate samples and 8.41 million provider/rate samples across national PPO plans from United Healthcare, Aetna and Cigna.

The findings are directly relevant to independent practices evaluating payer contracts, network participation and affiliation decisions. Nationally, providers in the 1,000-2,999 bin were more than four times as likely as providers in the 1-9 bin to receive at least 200% of their state's average Medicare reimbursement for CPT 99213. At the same time, the data showed substantial overlap between group-size bins, a provider-weighted standard deviation of 58% in Medicare-normalized rates and a weak national correlation between provider group size and rate outcome (+0.06).

For independent practices, the practical implication is not simply that scale wins. Rather, the results suggest that contracting leverage and reimbursement opportunity are shaped by a mix of market, payer and contracting factors, making rigorous local benchmarking essential for practices seeking to remain autonomous while improving reimbursement performance.

Key findings from the Reveon Health January 2026 TiC case study include:

• Median negotiated rates for CPT 99213 in the 1,000-2,999 provider bin were approximately 33% higher than in the 1-9 provider bin nationally.
• Providers in the 1,000-2,999 bin were more than four times as likely as providers in the 1-9 bin to receive at least 200% of the state's average Medicare rate for CPT 99213.
• Rate variation remained substantial even after state-level Medicare normalization, with a provider-weighted standard deviation of 58%.
• For two of the three insurers analyzed, rate outcomes declined above the 3,000-provider threshold.
• The study's results are descriptive, not causal, and the observed differences should not be interpreted as evidence that provider group size itself drives negotiated rate outcomes.

The analysis was not designed to rank insurers or determine causality between provider consolidation and negotiated rates. Instead, it documents how negotiated outcomes for CPT 99213 can vary across payers, regions and contracting structures, underscoring the value of local, payer-specific benchmarking in empowering negotiations.

The full case study, "Rate Variability by Provider Group Size," is available at https://reveonhealth.com/a-tic-data-analysis-of-the-negotiated-commercial-rates-for-cpt-99213/. Reveon Health welcomes research, media and provider inquiries at [email protected].

About Reveon Health

Reveon Health helps providers use Transparency in Coverage data to benchmark rates, evaluate networks and negotiate smarter, with a focus on preserving autonomy and financial sustainability for independent practices.

Contact:
Farra Lanzer-White
970-541-3284
[email protected]

SOURCE Reveon Health