Office Visit (New, High)
Office o/p new hi 60 min
National Average Cost (2026)
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Procedure Details
Understanding the Cost
Medicare rate is the amount Medicare pays providers. If you have Medicare, you typically pay 20% of this amount after your deductible.
Private insurance plans negotiate their own rates, typically 130-200% of Medicare. Your out-of-pocket cost depends on your deductible, copay, and coinsurance.
Self-pay/cash prices vary widely. Many providers offer cash discounts of 20-40% off their standard charges. Always ask about cash pricing.
Office vs Hospital: the same procedure often costs less in a doctor's office than a hospital, because hospitals charge a separate facility fee.
Ways to Save on This Procedure
Compare Insurance Plans
Uninsured? Comparing marketplace plans could save you thousands on procedures like this.
Compare plans on eHealth →Try Telehealth First
Many consultations can be done virtually for $50-100, saving hundreds vs an in-person visit.
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If this procedure leads to a prescription, check discount cards for up to 80% savings.
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More ways to save →Office Visit (New, High) (CPT 99205): Frequently Asked Questions
How much does office visit (new, high) cost?
The 2026 national Medicare rate for office visit (new, high) (CPT 99205) is $236.81 in an office setting and $160.32 in a hospital. Private insurance usually pays $308 to $474, and self-pay cash prices often run $189 to $355. Enter your ZIP code for a locality-adjusted rate.
Why does office visit (new, high) cost more in a hospital than an office?
Medicare pays a separate facility fee to hospitals, so the hospital (facility) rate of $160.32 differs from the office (non-facility) rate of $236.81. Where clinically appropriate, having the procedure in an office or outpatient setting is often cheaper.
What is CPT code 99205?
CPT code 99205 is the standard medical billing code for office visit (new, high). Providers use it to bill insurers, and Medicare sets a national reimbursement rate for it that is adjusted by geographic locality.
How can I pay less for office visit (new, high)?
Ask the provider for a self-pay or cash price before booking, as many discount 20-40% for upfront payment. If you are uninsured, compare marketplace insurance plans, consider telehealth for the consultation, and check prescription discount cards for any follow-up medication.