Office Visit (New, Low) Cost in Maine
Office o/p new low 30 min
$112.96Maine 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
Maine Medicare physician rate (2026)
-3.9% vs nationalAverage of 2 localities. Office range $110.85–$115.07.
Your ZIP in Maine
Enter a ZIP code for your part of Maine, whether the Portland area, Lewiston-Auburn, Augusta, Bangor, the midcoast, or Aroostook County in the far north.
What office visit (new, low) costs at hospitals near you
Everything above is a national average. The hospital you pick in Maine 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 Maine the office and hospital physician lines for this CPT differ by $44.05.
National vs Maine
Where Maine ranks for this CPT
CPT 99203 by Maine locality
| Locality | Office |
|---|---|
| southern maine | $115.07 |
| rest of maine | $110.85 |
PE GPCI ranges from 0.920 to 0.991 in Maine. That index is why the same CPT is not one price statewide.
Office Visit (New, Low) and how Maine is priced
Maine is priced as a single statewide locality with indices close to, and in parts below, the national average, so Portland and the far northern county towns share one fee schedule. CMS has never needed to subdivide a state where even the largest metro is modest by national standards. The uniform pricing belies enormous differences in access between the populous southern coast and the vast interior. For Mainers, the published statewide rates are what Medicare approves everywhere from Kittery to Fort Kent.
Maine is among the most rural states in the country and has the oldest median age, a combination that concentrates specialty care in Portland and, to a lesser degree, Bangor and Lewiston. Residents of western and northern Maine can face hours of driving for procedures, and some in the far south use Boston hospitals for complex care. Consolidation has left a small number of systems covering most of the state.
This procedure: This is a new-patient office visit of low complexity: your first appointment with a practice in at least three years, for a problem that is relatively contained, such as a stable rash, a minor joint complaint, or a straightforward infection. The clinician takes your history, examines you, and forms a plan, typically across 30 to 44 minutes when billed by time. New-patient visits pay more than established-patient visits because building your baseline record takes longer.
What Is Office Visit (New, Low)?
This is a new-patient office visit of low complexity: your first appointment with a practice in at least three years, for a problem that is relatively contained, such as a stable rash, a minor joint complaint, or a straightforward infection. The clinician takes your history, examines you, and forms a plan, typically across 30 to 44 minutes when billed by time. New-patient visits pay more than established-patient visits because building your baseline record takes longer.
What Affects the Cost
- –New-patient codes price meaningfully above the equivalent established-patient visit, a one-time premium for joining a practice.
- –Hospital-owned practices add a facility fee to office visits that independent practices cannot, sometimes doubling the encounter cost.
- –Any labs, ECGs, or procedures done during the visit bill on top of the visit code.
- –Specialist new-patient visits at this same code level are billed at higher charge-master rates than primary care in many systems.
- –If your problem turns out more complex than expected, the visit may be coded a level higher (99204) at a higher price.
Questions to Ask Before Booking
- 1.Am I being seen as a new patient, and what is the price difference versus an established visit?
- 2.Is this practice hospital-owned, and will a facility fee be added to my visit?
- 3.What will any labs or tests today add to the bill?
- 4.If I also want my annual physical, will that be billed separately from this problem visit?
- 5.What is your self-pay price for this visit level if I have a high deductible?
Other featured procedures in Maine
Office Visit (New, Low) in other states
Office Visit (New, Low) in Maine: questions
The 2026 Medicare physician office rate for CPT 99203 averages $112.96 across 2 Maine localities, from $110.85 in REST OF MAINE to $115.07 in SOUTHERN MAINE. The hospital physician rate averages $68.91. Enter a ZIP for the exact locality.
Yes. CMS splits Maine into 2 payment localities. For this CPT the office physician fee spans $4.22 from the lowest to highest locality. Enter a ZIP code for your part of Maine, whether the Portland area, Lewiston-Auburn, Augusta, Bangor, the midcoast, or Aroostook County in the far north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $23 for the office physician line or $14 for the hospital physician line in Maine. Medigap may cover that 20%. This is not the hospital facility fee.
No. $112.96 is the Medicare physician allowed amount for CPT 99203. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Maine ranks #19 of 51 states on this physician line (4% below the national office rate of $117.57).