How Much Does an Office Visit (Established, Moderate) Cost in Missouri?
Office o/p est low 20 min
$91.13Missouri physician fee2026 Medicare office rateUnder 2026 Medicare rates, an office visit (established, moderate) costs about $91 in Missouri, from $88 in Rest of Missouri to $93 in Metropolitan St. Louis. When it is billed from a hospital-based clinic, the physician is paid about $57 and the hospital adds its own facility fee.
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Missouri Medicare physician rate (2026)
-4.3% vs nationalAverage of 3 localities. Office range $88.38–$92.86.
Your ZIP in Missouri
Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
What office visit (established, moderate) costs at hospitals near you
Everything above is a national average. The hospital you pick in Missouri 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.
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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 center 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 Missouri the office and hospital physician lines for this CPT differ by $34.63.
National vs Missouri
Where Missouri ranks for this CPT
CPT 99213 by Missouri locality
| Locality | Office |
|---|---|
| metropolitan st. louis | $92.86 |
| metropolitan kansas city | $92.15 |
| rest of missouri | $88.38 |
PE GPCI ranges from 0.862 to 0.952 in Missouri. That index is why the same CPT is not one price statewide.
Office Visit (Established, Moderate) and how Missouri is priced
Missouri is a three-locality state: metropolitan St. Louis and metropolitan Kansas City are each priced separately, and everywhere else falls into a rest-of-state locality with lower geographic adjustments. Both metro localities approve higher amounts than outstate Missouri, and the Kansas City locality applies only to the Missouri side of that metro, since the Kansas side prices under Kansas's statewide locality. Springfield, Columbia, and the rural counties all share rest-of-state factors. The metro-versus-outstate gap is the main pricing story here.
St. Louis and Kansas City hold the state's academic medical centers and most of its specialty depth, drawing patients from far beyond Missouri's borders, including southern Illinois and eastern Kansas. Outstate Missouri is served by regional hubs in Springfield, Columbia, and Cape Girardeau, with the Ozarks and Bootheel among the harder places to reach specialty care. Rural hospital viability has been a persistent concern across the state.
This procedure: This is the routine follow-up appointment of American medicine: an established-patient office visit of low-to-moderate complexity, such as a blood pressure check with a medication refill, a stable chronic condition review, or a minor new complaint. Billed by time it covers 20 to 29 minutes on the visit date. It is among the most frequently billed codes in the entire healthcare system, the standard quick-but-real doctor visit.
What Is Office Visit (Established, Moderate)?
This is the routine follow-up appointment of American medicine: an established-patient office visit of low-to-moderate complexity, such as a blood pressure check with a medication refill, a stable chronic condition review, or a minor new complaint. Billed by time it covers 20 to 29 minutes on the visit date. It is among the most frequently billed codes in the entire healthcare system, the standard quick-but-real doctor visit.
What Affects the Cost
- –Established-patient status keeps the price below any new-patient visit; this level is typically the cheapest substantive visit on a fee schedule after the minimal 99212.
- –Hospital-owned clinics attach facility fees that can exceed the visit fee itself, turning a modest checkup into a two-part bill.
- –In-visit extras like rapid tests, ECGs, or injections each bill on top.
- –Chronic disease management means this visit recurs several times a year indefinitely, so its price is a recurring subscription in practice.
- –Telehealth versions bill the same code, sometimes with different plan cost sharing than in-person.
Questions to Ask Before Booking
- 1.What is my copay or the negotiated rate for a level-three established visit here?
- 2.Will anything done today, tests or injections, be billed on top of the visit?
- 3.Does this clinic charge a facility fee on office visits?
- 4.How many follow-ups per year should I expect for my condition, and can any be telehealth?
- 5.Is a telehealth visit cheaper under my plan than coming in?
Other featured procedures in Missouri
Office Visit (Established, Moderate) in other states
Office Visit (Established, Moderate) in Missouri: questions
Under 2026 Medicare rates, an office visit (established, moderate) costs about $91 in Missouri, from $88 in Rest of Missouri to $93 in Metropolitan St. Louis. When it is billed from a hospital-based clinic, the physician is paid about $57 and the hospital adds its own facility fee. Enter a ZIP for the exact Missouri locality.
Yes. CMS splits Missouri into 3 payment localities. For this CPT the office physician fee spans $4.48 from the lowest to highest locality. Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $18 for the office physician line or $11 for the hospital physician line in Missouri. Medigap may cover that 20%. This is not the hospital facility fee.
No. $91.13 is the Medicare physician allowed amount for CPT 99213. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Missouri ranks #18 of 51 states on this physician line (4% below the national office rate of $95.19).