Office Visit (New, Low) Cost in Massachusetts
Office o/p new low 30 min
$125.52Massachusetts 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
Massachusetts Medicare physician rate (2026)
+6.8% vs nationalAverage of 2 localities. Office range $120.46–$130.58.
Your ZIP in Massachusetts
Look up your ZIP to see whether metro Boston or rest-of-state pricing applies, from Boston and Cambridge to Worcester, Springfield, the North and South Shores, and Cape Cod.
What office visit (new, low) costs at hospitals near you
Everything above is a national average. The hospital you pick in Massachusetts 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 Massachusetts the office and hospital physician lines for this CPT differ by $51.79.
National vs Massachusetts
Where Massachusetts ranks for this CPT
CPT 99203 by Massachusetts locality
| Locality | Office |
|---|---|
| metropolitan boston | $130.58 |
| rest of massachusetts | $120.46 |
PE GPCI ranges from 1.053 to 1.194 in Massachusetts. That index is why the same CPT is not one price statewide.
Office Visit (New, Low) and how Massachusetts is priced
Massachusetts is priced through two localities: metro Boston and the rest of the state. Boston's locality carries clearly higher geographic adjustments, reflecting some of the highest medical wages and office costs in the nation, while Worcester, Springfield, and the Cape share the lower rest-of-state factors. The split means the fee schedule itself acknowledges what everyone in the state already knows about Boston prices. Even so, rest-of-state Massachusetts still prices above most of the country.
Boston has arguably the densest concentration of academic medical centers anywhere, and its teaching hospitals pull referrals from all of New England and beyond. That prestige comes with a high-cost market structure that state policymakers have scrutinized for years. Western Massachusetts operates more like a regional market centered on Springfield, and Cape and islands residents contend with seasonal capacity strain.
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 Massachusetts
Office Visit (New, Low) in other states
Office Visit (New, Low) in Massachusetts: questions
The 2026 Medicare physician office rate for CPT 99203 averages $125.52 across 2 Massachusetts localities, from $120.46 in REST OF MASSACHUSETTS to $130.58 in METROPOLITAN BOSTON. The hospital physician rate averages $73.73. Enter a ZIP for the exact locality.
Yes. CMS splits Massachusetts into 2 payment localities. For this CPT the office physician fee spans $10.12 from the lowest to highest locality. Look up your ZIP to see whether metro Boston or rest-of-state pricing applies, from Boston and Cambridge to Worcester, Springfield, the North and South Shores, and Cape Cod.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $25 for the office physician line or $15 for the hospital physician line in Massachusetts. Medigap may cover that 20%. This is not the hospital facility fee.
No. $125.52 is the Medicare physician allowed amount for CPT 99203. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Massachusetts ranks #45 of 51 states on this physician line (7% above the national office rate of $117.57).