Office Visit (Established, Moderate) Cost in Missouri
Office o/p est low 20 min
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 this number is
The figures on this page are 2026 Medicare physician allowed amounts for a specific CPT code: the professional fee, adjusted by geographic practice-cost indices. They are not a hospital chargemaster price, not your insurer's contracted rate, and not a quote. Hospital facility fees, anesthesia, implants, imaging reads, and pathology are billed separately when they apply. 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
How much does office visit (established, moderate) cost in Missouri?
The 2026 Medicare physician office rate for CPT 99213 averages $91.13 across 3 Missouri localities, from $88.38 in REST OF MISSOURI to $92.86 in METROPOLITAN ST. LOUIS. The hospital physician rate averages $56.50. Enter a ZIP for the exact locality.
Does the rate change inside Missouri?
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.
What will a Medicare patient owe for the physician fee?
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.
Is this the full office visit (established, moderate) bill in Missouri?
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).