Office Visit (New, Moderate-High) Cost in Georgia
Office o/p new mod 45 min
$175.27Georgia 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)
-1.2% vs nationalAverage of 2 localities. Office range $169.99–$180.55.
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, moderate-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.
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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 $57.67.
National vs Georgia
Where Georgia ranks for this CPT
CPT 99204 by Georgia locality
| Locality | Office |
|---|---|
| atlanta | $180.55 |
| rest of georgia | $169.99 |
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, Moderate-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 a new-patient office visit of moderate to high complexity: your first visit to a practice in three years for a problem with real depth, such as multiple symptoms needing workup, a new chronic disease like diabetes, or several interacting conditions. When billed by time it represents 45 to 59 minutes on the visit date. It is the most commonly billed new-patient level in the United States, the default for a substantive first specialist or primary care appointment.
What Is Office Visit (New, Moderate-High)?
This is a new-patient office visit of moderate to high complexity: your first visit to a practice in three years for a problem with real depth, such as multiple symptoms needing workup, a new chronic disease like diabetes, or several interacting conditions. When billed by time it represents 45 to 59 minutes on the visit date. It is the most commonly billed new-patient level in the United States, the default for a substantive first specialist or primary care appointment.
What Affects the Cost
- –As the workhorse new-patient code, it prices well above 99203, and the level is set by the visit's complexity, not by what you expected walking in.
- –Specialist consultations commonly bill at this level, and specialist charge rates exceed primary care for the same code.
- –Diagnostic workups launched at this visit, labs, imaging referrals, and tests, are where the episode's real spending usually begins.
- –Facility fees at hospital-owned clinics inflate this visit substantially compared with independent offices.
- –Prolonged-service add-on codes can stack on top if the visit runs well past an hour.
Questions to Ask Before Booking
- 1.Does my plan require a referral for this specialist before the visit is covered?
- 2.What is the negotiated or cash price for a level-four new-patient visit here?
- 3.Which tests are you likely to order, and which of those need prior authorization?
- 4.Is there a facility fee because this clinic is hospital-owned?
- 5.If the visit runs long, could additional prolonged-service charges apply?
Other featured procedures in Georgia
Office Visit (New, Moderate-High) in other states
Office Visit (New, Moderate-High) in Georgia: questions
The 2026 Medicare physician office rate for CPT 99204 averages $175.27 across 2 Georgia localities, from $169.99 in REST OF GEORGIA to $180.55 in ATLANTA. The hospital physician rate averages $117.60. Enter a ZIP for the exact locality.
Yes. CMS splits Georgia into 2 payment localities. For this CPT the office physician fee spans $10.56 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 $35 for the office physician line or $24 for the hospital physician line in Georgia. Medigap may cover that 20%. This is not the hospital facility fee.
No. $175.27 is the Medicare physician allowed amount for CPT 99204. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Georgia ranks #28 of 51 states on this physician line (within 2% of the national office rate of $177.36).