Office Visit (New, Low) Cost
Office o/p new low 30 min
$117.57Medicare physician fee2026 national office rate- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough — no account, no insurance card.
What office visit (new, low) costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $46.09.
How CMS prices CPT 99203
Work is about 45% of the office total RVU; practice expense is about 50%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $117.57. Hospital (facility) physician rate: $71.48.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $24 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
What Is Office Visit (New, Low)?
This is a new-patient office visit of low complexity: your first appointment with a practice in at least three years, for a problem that is relatively contained, such as a stable rash, a minor joint complaint, or a straightforward infection. The clinician takes your history, examines you, and forms a plan, typically across 30 to 44 minutes when billed by time. New-patient visits pay more than established-patient visits because building your baseline record takes longer.
What Affects the Cost
- –New-patient codes price meaningfully above the equivalent established-patient visit, a one-time premium for joining a practice.
- –Hospital-owned practices add a facility fee to office visits that independent practices cannot, sometimes doubling the encounter cost.
- –Any labs, ECGs, or procedures done during the visit bill on top of the visit code.
- –Specialist new-patient visits at this same code level are billed at higher charge-master rates than primary care in many systems.
- –If your problem turns out more complex than expected, the visit may be coded a level higher (99204) at a higher price.
How It Is Billed
CPT 99203 is selected by either total time on the date of the visit (30 to 44 minutes) or low-complexity medical decision making, and it requires that no one in the same practice and specialty saw you in the past three years, otherwise established-patient codes apply. Vaccines, tests, and minor procedures during the visit bill separately. A visit dedicated to a problem cannot be a free preventive physical; those are different codes with different coverage.
Insurance & Coverage Notes
Problem-focused new-patient visits are covered under standard office visit benefits: a copay on many plans, or the full negotiated rate against your deductible on high-deductible plans. This is not a preventive visit, so the ACA free-physical benefit does not apply even if it is your first appointment. If you combine a first physical with a new problem, practices may legitimately bill both a preventive and a problem visit the same day, producing a copay you did not expect.
Questions to Ask Before Booking
- 1.Am I being seen as a new patient, and what is the price difference versus an established visit?
- 2.Is this practice hospital-owned, and will a facility fee be added to my visit?
- 3.What will any labs or tests today add to the bill?
- 4.If I also want my annual physical, will that be billed separately from this problem visit?
- 5.What is your self-pay price for this visit level if I have a high deductible?
Office Visit (New, Low) (CPT 99203): questions
The 2026 national Medicare physician rate for CPT 99203 is $117.57 in an office and $71.48 in a hospital. Enter a ZIP code to apply the geographic adjustment for your locality.
Medicare uses a different practice-expense RVU in a facility. For CPT 99203 that produces an office rate of $117.57 and a hospital physician rate of $71.48 (a $46.09 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
This is a new-patient office visit of low complexity: your first appointment with a practice in at least three years, for a problem that is relatively contained, such as a stable rash, a minor joint complaint, or a straightforward infection. The clinician takes your history, examines you, and forms a plan, typically across 30 to 44 minutes when billed by time. New-patient visits pay more than established-patient visits because building your baseline record takes longer. CMS bills it as “Office o/p new low 30 min.”
No. $117.57 is the physician allowed amount. Anesthesia, facility fees, implants, imaging interpretation billed under a different code, and pathology are separate when they apply. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.