Office Visit (Established, Moderate-High) Cost in Idaho
Office o/p est mod 30 min
$127.80Idaho 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
Idaho Medicare physician rate (2026)
-5.8% vs nationalSingle statewide locality.
Your ZIP in Idaho
Check your ZIP code for local context across Idaho, from Boise and the Treasure Valley to Coeur d'Alene, Idaho Falls, Pocatello, Twin Falls, and the remote central mountains.
What office visit (established, moderate-high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Idaho 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 Idaho the office and hospital physician lines for this CPT differ by $47.02.
National vs Idaho
Where Idaho ranks for this CPT
Office Visit (Established, Moderate-High) and how Idaho is priced
All of Idaho shares a single payment locality, and its geographic indices are among the lowest in the West, so Medicare-approved amounts here undercut those in neighboring Washington and Oregon metro localities. Boise's rapid growth has not changed the statewide pricing structure; the fee schedule treats the Treasure Valley the same as the Panhandle or the eastern farm counties. For patients, that uniformity makes the statewide figures on this site a reliable guide anywhere in Idaho. Cross-border care is where pricing gets more interesting, since adjacent metro localities price higher.
Boise anchors the state's largest medical market, while the Panhandle looks to Spokane, Washington for much of its specialty care and eastern Idaho leans on Idaho Falls, Pocatello, and sometimes Salt Lake City. That means many Idahoans actually receive care priced under another state's locality. Rural and mountain communities face long drives for anything beyond primary care.
This procedure: This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Is Office Visit (Established, Moderate-High)?
This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Affects the Cost
- –It reimburses meaningfully more than 99213, and which of the two your visit becomes depends on documented complexity you cannot see from the waiting room.
- –Multi-condition patients land here repeatedly through the year, compounding the higher per-visit rate.
- –Facility fees at hospital-owned practices add a second charge to every visit at any level.
- –In-office tests, injections, or procedures stack as separate lines.
- –Specialist follow-ups at this level are priced above primary care equivalents in most charge masters.
Questions to Ask Before Booking
- 1.What determines whether my visit bills as level three or four, and what is the price difference for me?
- 2.During my deductible phase, what is the negotiated rate for this level here?
- 3.Will medication changes today push the visit to a higher level?
- 4.Are any of today's services billed separately from the visit code?
- 5.Can complex medication reviews be split across telehealth check-ins at lower cost?
Other featured procedures in Idaho
Office Visit (Established, Moderate-High) in other states
Office Visit (Established, Moderate-High) in Idaho: questions
Idaho is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99214 is $127.80 in an office and $80.78 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Idaho uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $26 for the office physician line or $16 for the hospital physician line in Idaho. Medigap may cover that 20%. This is not the hospital facility fee.
No. $127.80 is the Medicare physician allowed amount for CPT 99214. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Idaho ranks #9 of 51 states on this physician line (6% below the national office rate of $135.61).