Office Visit (New, Low) Cost in California
Office o/p new low 30 min
$127.81California physician fee2026 Medicare 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
California Medicare physician rate (2026)
+8.7% vs nationalAverage of 29 localities. Office range $121.64–$146.95.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What office visit (new, low) costs at hospitals near you
Everything above is a national average. The hospital you pick in California 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. In California the office and hospital physician lines for this CPT differ by $54.54.
National vs California
Where California ranks for this CPT
CPT 99203 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $146.95 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $146.21 |
| san francisco-oakland-berkeley (marin cnty) | $143.86 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $143.68 |
| napa | $137.00 |
| vallejo | $136.74 |
| santa rosa-petaluma | $130.10 |
| santa cruz-watsonville | $128.85 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $128.72 |
| san diego-chula vista-carlsbad | $128.25 |
| oxnard-thousand oaks-ventura | $127.75 |
| sacramento-roseville-folsom | $126.60 |
| santa maria-santa barbara | $126.35 |
| salinas | $126.10 |
| san luis obispo-paso robles | $124.17 |
| riverside-san bernardino-ontario | $123.39 |
| bakersfield | $122.14 |
| el centro | $121.67 |
| chico | $121.64 |
| fresno | $121.64 |
| hanford-corcoran | $121.64 |
| madera | $121.64 |
| merced | $121.64 |
| modesto | $121.64 |
| redding | $121.64 |
| stockton | $121.64 |
| visalia | $121.64 |
| yuba city | $121.64 |
| rest of california | $121.64 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Office Visit (New, Low) and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: 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 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.
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?
Other featured procedures in California
Office Visit (New, Low) in other states
Office Visit (New, Low) in California: questions
The 2026 Medicare physician office rate for CPT 99203 averages $127.81 across 29 California localities, from $121.64 in CHICO to $146.95 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $73.27. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $25.31 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $26 for the office physician line or $15 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $127.81 is the Medicare physician allowed amount for CPT 99203. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. California ranks #47 of 51 states on this physician line (9% above the national office rate of $117.57).