How Much Does an Office Visit (New, High) Cost in Missouri?
Office o/p new hi 60 min
$227.74Missouri physician fee2026 Medicare office rateUnder 2026 Medicare rates, an office visit (new, high) costs about $228 in Missouri, from $222 in Rest of Missouri to $232 in Metropolitan St. Louis. When it is billed from a hospital-based clinic, the physician is paid about $158 and the hospital adds its own facility fee.
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Missouri Medicare physician rate (2026)
-3.8% vs nationalAverage of 3 localities. Office range $221.61–$231.66.
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 (new, high) 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 $70.19.
National vs Missouri
Where Missouri ranks for this CPT
CPT 99205 by Missouri locality
| Locality | Office |
|---|---|
| metropolitan st. louis | $231.66 |
| metropolitan kansas city | $229.95 |
| rest of missouri | $221.61 |
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 (New, High) 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 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 Missouri
Office Visit (New, High) in other states
Office Visit (New, High) in Missouri: questions
Under 2026 Medicare rates, an office visit (new, high) costs about $228 in Missouri, from $222 in Rest of Missouri to $232 in Metropolitan St. Louis. When it is billed from a hospital-based clinic, the physician is paid about $158 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 $10.05 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 $46 for the office physician line or $32 for the hospital physician line in Missouri. Medigap may cover that 20%. This is not the hospital facility fee.
No. $227.74 is the Medicare physician allowed amount for CPT 99205. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Missouri ranks #17 of 51 states on this physician line (4% below the national office rate of $236.81).