Office Visit (New, Moderate-High) Cost in Kentucky
Office o/p new mod 45 min
$167.52Kentucky 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
Kentucky Medicare physician rate (2026)
-5.5% vs nationalSingle statewide locality.
Your ZIP in Kentucky
Use a ZIP lookup for your area of Kentucky, whether Louisville, Lexington, the northern Kentucky suburbs of Cincinnati, Bowling Green, Owensboro, or the Appalachian east.
What office visit (new, moderate-high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Kentucky 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 Kentucky the office and hospital physician lines for this CPT differ by $53.75.
National vs Kentucky
Where Kentucky ranks for this CPT
Office Visit (New, Moderate-High) and how Kentucky is priced
Kentucky's fee schedule runs on one statewide locality, with geographic indices below the national average, so Louisville, Lexington, and the Appalachian east all publish the same Medicare-approved amounts. The uniform locality smooths over a state with sharp internal contrasts, from urban river cities to some of the most rural counties in America. Because the adjustments are identical everywhere, the statewide figures here transfer cleanly to any Kentucky address. Setting of care, office versus hospital outpatient, remains the biggest driver of what a patient actually pays.
Louisville and Lexington host the state's two academic medical centers and absorb referrals from a wide rural hinterland, while northern Kentucky functions as part of the Cincinnati market across the river. Eastern Kentucky's mountain counties face persistent physician shortages and long travel for specialty procedures. For residents along the borders, comparing against Cincinnati, Nashville, or Huntington providers is often worthwhile.
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 Kentucky
Office Visit (New, Moderate-High) in other states
Office Visit (New, Moderate-High) in Kentucky: questions
Kentucky is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99204 is $167.52 in an office and $113.77 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Kentucky 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 $34 for the office physician line or $23 for the hospital physician line in Kentucky. Medigap may cover that 20%. This is not the hospital facility fee.
No. $167.52 is the Medicare physician allowed amount for CPT 99204. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Kentucky ranks #11 of 51 states on this physician line (6% below the national office rate of $177.36).