Office Visit (New, Moderate-High) Cost in Missouri
Office o/p new mod 45 min
Missouri Medicare physician rate (2026)
-3.9% vs nationalAverage of 3 localities. Office range $165.77–$173.41.
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 $55.48.
National vs Missouri
Where Missouri ranks for this CPT
CPT 99204 by Missouri locality
| Locality | Office |
|---|---|
| metropolitan st. louis | $173.41 |
| metropolitan kansas city | $172.14 |
| rest of missouri | $165.77 |
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, Moderate-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 a new-patient office visit of moderate to high complexity: your first visit to a practice in three years for a problem with real depth, such as multiple symptoms needing workup, a new chronic disease like diabetes, or several interacting conditions. When billed by time it represents 45 to 59 minutes on the visit date. It is the most commonly billed new-patient level in the United States, the default for a substantive first specialist or primary care appointment.
What Is Office Visit (New, Moderate-High)?
This is a new-patient office visit of moderate to high complexity: your first visit to a practice in three years for a problem with real depth, such as multiple symptoms needing workup, a new chronic disease like diabetes, or several interacting conditions. When billed by time it represents 45 to 59 minutes on the visit date. It is the most commonly billed new-patient level in the United States, the default for a substantive first specialist or primary care appointment.
What Affects the Cost
- As the workhorse new-patient code, it prices well above 99203, and the level is set by the visit's complexity, not by what you expected walking in.
- Specialist consultations commonly bill at this level, and specialist charge rates exceed primary care for the same code.
- Diagnostic workups launched at this visit, labs, imaging referrals, and tests, are where the episode's real spending usually begins.
- Facility fees at hospital-owned clinics inflate this visit substantially compared with independent offices.
- Prolonged-service add-on codes can stack on top if the visit runs well past an hour.
Questions to Ask Before Booking
- 1.Does my plan require a referral for this specialist before the visit is covered?
- 2.What is the negotiated or cash price for a level-four new-patient visit here?
- 3.Which tests are you likely to order, and which of those need prior authorization?
- 4.Is there a facility fee because this clinic is hospital-owned?
- 5.If the visit runs long, could additional prolonged-service charges apply?
Other featured procedures in Missouri
Office Visit (New, Moderate-High) in other states
Office Visit (New, Moderate-High) in Missouri: questions
How much does office visit (new, moderate-high) cost in Missouri?
The 2026 Medicare physician office rate for CPT 99204 averages $170.44 across 3 Missouri localities, from $165.77 in REST OF MISSOURI to $173.41 in METROPOLITAN ST. LOUIS. The hospital physician rate averages $114.96. 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 $7.64 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 $34 for the office physician line or $23 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 (new, moderate-high) bill in Missouri?
No. $170.44 is the Medicare physician allowed amount for CPT 99204. 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 $177.36).