Office Visit (New, High) Cost in Georgia
Office o/p new hi 60 min
$234.39Georgia 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
Georgia Medicare physician rate (2026)
-1.0% vs nationalAverage of 2 localities. Office range $227.47–$241.31.
Your ZIP in Georgia
Look up your ZIP to see whether Atlanta-area or rest-of-state pricing applies, from the metro counties to Savannah, Augusta, Columbus, Macon, and rural south Georgia.
What office visit (new, high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Georgia 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 Georgia the office and hospital physician lines for this CPT differ by $72.97.
National vs Georgia
Where Georgia ranks for this CPT
CPT 99205 by Georgia locality
| Locality | Office |
|---|---|
| atlanta | $241.31 |
| rest of georgia | $227.47 |
PE GPCI ranges from 0.892 to 1.016 in Georgia. That index is why the same CPT is not one price statewide.
Office Visit (New, High) and how Georgia is priced
Georgia divides into an Atlanta metro locality and a rest-of-state locality, so the fee schedule itself recognizes the cost gap between the capital region and the rest of the state. Atlanta's higher wages and rents translate into higher Medicare-approved amounts inside its locality, while Savannah, Augusta, Columbus, Macon, and rural Georgia share the lower rest-of-state pricing. The split is one of the cleaner examples of a two-tier state in the fee schedule. Patients near the locality boundary can see different approved amounts a short drive apart.
Metro Atlanta concentrates the state's academic medicine and most of its subspecialists, drawing referrals from across the Southeast. Outside the metro, south Georgia has seen repeated rural hospital closures, leaving longer trips for even routine procedures in some counties. Augusta and Savannah serve as important secondary hubs, and border residents sometimes cross into Chattanooga, Tallahassee, or Jacksonville for care.
This procedure: This is the highest-level new-patient office visit, reserved for genuinely complex first encounters: multiple serious conditions, a diagnosis that could threaten life or function, or decisions about major interventions. Billed by time, it means 60 to 74 minutes with the clinician on the visit date. Typical examples include a first oncology consultation, a complicated multi-system workup, or a new patient with several unstable chronic diseases.
What Is Office Visit (New, High)?
This is the highest-level new-patient office visit, reserved for genuinely complex first encounters: multiple serious conditions, a diagnosis that could threaten life or function, or decisions about major interventions. Billed by time, it means 60 to 74 minutes with the clinician on the visit date. Typical examples include a first oncology consultation, a complicated multi-system workup, or a new patient with several unstable chronic diseases.
What Affects the Cost
- –It is the most expensive standard office visit code, and practices reserve it for their longest, most involved new consultations.
- –The specialists who bill it most, oncologists, rheumatologists, complex-care internists, tend to practice in hospital systems where facility fees compound the professional charge.
- –Visits this complex almost always launch expensive diagnostics: advanced imaging, biopsies, or specialty labs, each billed separately.
- –Prolonged-service add-on codes attach beyond 74 minutes, extending the charge further.
- –Second-opinion consultations at academic centers often bill at this level with academic-center pricing.
Questions to Ask Before Booking
- 1.What is the charge for this highest-level consultation, including any facility fee?
- 2.Does my plan need a referral on file before this visit?
- 3.Which of the tests and treatments you are recommending need prior authorization?
- 4.Is every provider involved in my workup, radiology, pathology, labs, in my network?
- 5.If this is a second opinion, does my plan have a program that covers it in full?
Other featured procedures in Georgia
Office Visit (New, High) in other states
Office Visit (New, High) in Georgia: questions
The 2026 Medicare physician office rate for CPT 99205 averages $234.39 across 2 Georgia localities, from $227.47 in REST OF GEORGIA to $241.31 in ATLANTA. The hospital physician rate averages $161.42. Enter a ZIP for the exact locality.
Yes. CMS splits Georgia into 2 payment localities. For this CPT the office physician fee spans $13.84 from the lowest to highest locality. Look up your ZIP to see whether Atlanta-area or rest-of-state pricing applies, from the metro counties to Savannah, Augusta, Columbus, Macon, and rural south Georgia.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $47 for the office physician line or $32 for the hospital physician line in Georgia. Medigap may cover that 20%. This is not the hospital facility fee.
No. $234.39 is the Medicare physician allowed amount for CPT 99205. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Georgia ranks #29 of 51 states on this physician line (within 2% of the national office rate of $236.81).