Office Visit (Established, Moderate) Cost
Office o/p est low 20 min
$95.19Medicare 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 (established, moderate) 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 $37.74.
How CMS prices CPT 99213
Work is about 46% of the office total RVU; practice expense is about 51%. 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: $95.19. Hospital (facility) physician rate: $57.45.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $19 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 (Established, Moderate)?
This is the routine follow-up appointment of American medicine: an established-patient office visit of low-to-moderate complexity, such as a blood pressure check with a medication refill, a stable chronic condition review, or a minor new complaint. Billed by time it covers 20 to 29 minutes on the visit date. It is among the most frequently billed codes in the entire healthcare system, the standard quick-but-real doctor visit.
What Affects the Cost
- –Established-patient status keeps the price below any new-patient visit; this level is typically the cheapest substantive visit on a fee schedule after the minimal 99212.
- –Hospital-owned clinics attach facility fees that can exceed the visit fee itself, turning a modest checkup into a two-part bill.
- –In-visit extras like rapid tests, ECGs, or injections each bill on top.
- –Chronic disease management means this visit recurs several times a year indefinitely, so its price is a recurring subscription in practice.
- –Telehealth versions bill the same code, sometimes with different plan cost sharing than in-person.
How It Is Billed
CPT 99213 requires low-complexity medical decision making or 20 to 29 minutes of total time for a patient seen by the practice within three years. If your stable visit involved more problems or prescription decisions with meaningful risk, 99214 is justified instead, which is why identical-feeling visits sometimes bill differently. Add-on charges for tests and procedures are separate, and Medicare wellness visits are distinct codes that cannot be swapped in for a problem visit.
Insurance & Coverage Notes
Most plans apply a flat office-visit copay to this code once applicable, making it one of the most predictable costs in healthcare; high-deductible members pay the negotiated rate, which differs surprisingly between practices for the same code. It is a problem visit, not preventive, so it never qualifies for zero-cost-share preventive coverage. Telehealth billing of this code is covered by most plans, occasionally with lower or waived cost sharing.
Questions to Ask Before Booking
- 1.What is my copay or the negotiated rate for a level-three established visit here?
- 2.Will anything done today, tests or injections, be billed on top of the visit?
- 3.Does this clinic charge a facility fee on office visits?
- 4.How many follow-ups per year should I expect for my condition, and can any be telehealth?
- 5.Is a telehealth visit cheaper under my plan than coming in?
Office Visit (Established, Moderate) (CPT 99213): questions
The 2026 national Medicare physician rate for CPT 99213 is $95.19 in an office and $57.45 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 99213 that produces an office rate of $95.19 and a hospital physician rate of $57.45 (a $37.74 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
This is the routine follow-up appointment of American medicine: an established-patient office visit of low-to-moderate complexity, such as a blood pressure check with a medication refill, a stable chronic condition review, or a minor new complaint. Billed by time it covers 20 to 29 minutes on the visit date. It is among the most frequently billed codes in the entire healthcare system, the standard quick-but-real doctor visit. CMS bills it as “Office o/p est low 20 min.”
No. $95.19 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.