Office Visit (New, Moderate-High) Cost in Kansas
Office o/p new mod 45 min
Kansas Medicare physician rate (2026)
-6.7% vs nationalSingle statewide locality.
Your ZIP in Kansas
Enter a ZIP code for your part of Kansas, from Overland Park and the Kansas City suburbs to Wichita, Topeka, Lawrence, Salina, and the western High Plains.
What this number is
The figures on this page are 2026 Medicare physician allowed amounts for a specific CPT code: the professional fee, adjusted by geographic practice-cost indices. They are not a hospital chargemaster price, not your insurer's contracted rate, and not a quote. Hospital facility fees, anesthesia, implants, imaging reads, and pathology are billed separately when they apply. In Kansas the office and hospital physician lines for this CPT differ by $54.65.
National vs Kansas
Where Kansas ranks for this CPT
Office Visit (New, Moderate-High) and how Kansas is priced
A single locality covers all of Kansas, with geographic indices in the lower national tier, so the published Medicare rates apply evenly from the Kansas City suburbs to the far western High Plains. Notably, the Kansas side of the Kansas City metro prices under the statewide Kansas locality while the Missouri side has its own metro locality, meaning the two halves of one city carry different approved amounts. Beyond that quirk, Kansas pricing is straightforwardly uniform. Wichita, Topeka, and rural Kansas all share the same adjustments.
The Kansas City metro and Wichita hold most of the state's specialists, with the academic medical center on the Kansas side of the metro serving as the top referral point. Western Kansas is genuinely frontier in places, with long distances to any hospital that performs advanced procedures, and some High Plains residents cross into Colorado or Nebraska for care. Critical access hospitals carry much of the rural load.
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 Kansas
Office Visit (New, Moderate-High) in other states
Office Visit (New, Moderate-High) in Kansas: questions
How much does office visit (new, moderate-high) cost in Kansas?
Kansas is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99204 is $165.46 in an office and $110.81 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Does the rate change inside Kansas?
Not on the physician fee schedule. Kansas 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.
What will a Medicare patient owe for the physician fee?
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 Kansas. Medigap may cover that 20%. This is not the hospital facility fee.
Is this the full office visit (new, moderate-high) bill in Kansas?
No. $165.46 is the Medicare physician allowed amount for CPT 99204. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Kansas ranks #4 of 51 states on this physician line (7% below the national office rate of $177.36).