Office Visit (New, High) Cost in Maryland
Office o/p new hi 60 min
$243.85Maryland 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
Maryland Medicare physician rate (2026)
+3.0% vs nationalAverage of 2 localities. Office range $238.29–$249.41.
Your ZIP in Maryland
A ZIP lookup matters in Maryland because three different locality treatments are in play: check whether you fall in the Baltimore area, the DC suburbs like Bethesda and Silver Spring, or rest-of-state regions like Frederick, Hagerstown, and the Eastern Shore.
What office visit (new, high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Maryland 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 Maryland the office and hospital physician lines for this CPT differ by $79.74.
National vs Maryland
Where Maryland ranks for this CPT
CPT 99205 by Maryland locality
| Locality | Office |
|---|---|
| baltimore/surr. cntys | $249.41 |
| rest of maryland | $238.29 |
PE GPCI ranges from 1.012 to 1.073 in Maryland. That index is why the same CPT is not one price statewide.
Office Visit (New, High) and how Maryland is priced
Maryland's Medicare physician pricing is split geographically: Baltimore and its surrounding counties form one locality, the rest of the state another, and, unusually, the Washington suburbs including Montgomery and Prince George's counties are priced inside the District of Columbia's high-cost locality rather than either Maryland one. That three-way carve means a Rockville procedure is approved at DC-area rates while an identical one in Frederick or Salisbury is not. Baltimore-area adjustments sit above rest-of-state levels but below the DC locality. Few states have their pricing shaped this much by a neighboring jurisdiction.
Maryland is also the only state with an all-payer rate-setting system for hospital services, so hospital-side billing works differently here than anywhere else in the country, though physician fees still follow the standard Medicare schedule. Baltimore's academic medical centers rank among the most prominent in the world and draw patients globally. The Eastern Shore and western Maryland are far more rural, with patients often traveling to Baltimore, Annapolis, or across state lines.
This procedure: This is the highest-level new-patient office visit, reserved for genuinely complex first encounters: multiple serious conditions, a diagnosis that could threaten life or function, or decisions about major interventions. Billed by time, it means 60 to 74 minutes with the clinician on the visit date. Typical examples include a first oncology consultation, a complicated multi-system workup, or a new patient with several unstable chronic diseases.
What Is Office Visit (New, High)?
This is the highest-level new-patient office visit, reserved for genuinely complex first encounters: multiple serious conditions, a diagnosis that could threaten life or function, or decisions about major interventions. Billed by time, it means 60 to 74 minutes with the clinician on the visit date. Typical examples include a first oncology consultation, a complicated multi-system workup, or a new patient with several unstable chronic diseases.
What Affects the Cost
- –It is the most expensive standard office visit code, and practices reserve it for their longest, most involved new consultations.
- –The specialists who bill it most, oncologists, rheumatologists, complex-care internists, tend to practice in hospital systems where facility fees compound the professional charge.
- –Visits this complex almost always launch expensive diagnostics: advanced imaging, biopsies, or specialty labs, each billed separately.
- –Prolonged-service add-on codes attach beyond 74 minutes, extending the charge further.
- –Second-opinion consultations at academic centers often bill at this level with academic-center pricing.
Questions to Ask Before Booking
- 1.What is the charge for this highest-level consultation, including any facility fee?
- 2.Does my plan need a referral on file before this visit?
- 3.Which of the tests and treatments you are recommending need prior authorization?
- 4.Is every provider involved in my workup, radiology, pathology, labs, in my network?
- 5.If this is a second opinion, does my plan have a program that covers it in full?
Other featured procedures in Maryland
Office Visit (New, High) in other states
Office Visit (New, High) in Maryland: questions
The 2026 Medicare physician office rate for CPT 99205 averages $243.85 across 2 Maryland localities, from $238.29 in REST OF MARYLAND to $249.41 in BALTIMORE/SURR. CNTYS. The hospital physician rate averages $164.11. Enter a ZIP for the exact locality.
Yes. CMS splits Maryland into 2 payment localities. For this CPT the office physician fee spans $11.12 from the lowest to highest locality. A ZIP lookup matters in Maryland because three different locality treatments are in play: check whether you fall in the Baltimore area, the DC suburbs like Bethesda and Silver Spring, or rest-of-state regions like Frederick, Hagerstown, and the Eastern Shore.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $49 for the office physician line or $33 for the hospital physician line in Maryland. Medigap may cover that 20%. This is not the hospital facility fee.
No. $243.85 is the Medicare physician allowed amount for CPT 99205. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Maryland ranks #41 of 51 states on this physician line (3% above the national office rate of $236.81).