How Much Does an Office Visit (New, Moderate-High) Cost in Idaho?
Office o/p new mod 45 min
$166.53Idaho physician fee2026 Medicare office rateUnder 2026 Medicare rates, an office visit (new, moderate-high) costs about $167 in Idaho. When it is billed from a hospital-based clinic, the physician is paid about $111 and the hospital adds its own facility fee.
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- ✓The add-on codes that typically land on the bill
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Idaho Medicare physician rate (2026)
-6.1% 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 (new, 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.
For example 83201.
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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 center 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 $55.61.
National vs Idaho
Where Idaho ranks for this CPT
Office Visit (New, 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 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 Idaho
Office Visit (New, Moderate-High) in other states
Office Visit (New, Moderate-High) in Idaho: questions
Under 2026 Medicare rates, an office visit (new, moderate-high) costs about $167 in Idaho. When it is billed from a hospital-based clinic, the physician is paid about $111 and the hospital adds its own facility fee. Idaho is a single Medicare locality, so the physician rate is the same statewide.
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 $33 for the office physician line or $22 for the hospital physician line in Idaho. Medigap may cover that 20%. This is not the hospital facility fee.
No. $166.53 is the Medicare physician allowed amount for CPT 99204. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Idaho ranks #8 of 51 states on this physician line (6% below the national office rate of $177.36).