Office Visit (New, Moderate-High) Cost in Maine
Office o/p new mod 45 min
$170.70Maine 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)
-3.8% vs nationalAverage of 2 localities. Office range $167.73–$173.66.
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, moderate-high) 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 $57.77.
National vs Maine
Where Maine ranks for this CPT
CPT 99204 by Maine locality
| Locality | Office |
|---|---|
| southern maine | $173.66 |
| rest of maine | $167.73 |
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, Moderate-High) 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 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 Maine
Office Visit (New, Moderate-High) in other states
Office Visit (New, Moderate-High) in Maine: questions
The 2026 Medicare physician office rate for CPT 99204 averages $170.70 across 2 Maine localities, from $167.73 in REST OF MAINE to $173.66 in SOUTHERN MAINE. The hospital physician rate averages $112.93. Enter a ZIP for the exact locality.
Yes. CMS splits Maine into 2 payment localities. For this CPT the office physician fee spans $5.93 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 $34 for the office physician line or $23 for the hospital physician line in Maine. Medigap may cover that 20%. This is not the hospital facility fee.
No. $170.70 is the Medicare physician allowed amount for CPT 99204. 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 $177.36).