CPT99213

Office Visit (Established, Moderate) Cost in New Hampshire

Office o/p est low 20 min

$96.82New Hampshire physician fee2026 Medicare office rate
Hospital payments are wage-adjusted by locality, so the ZIP changes the numbers.
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New Hampshire Medicare physician rate (2026)

+1.7% vs national

Single statewide locality.

New Hampshire (Hospital)
$57.53
Facility physician fee
Private plan est.
$126–$194
~130–200% of Medicare
Cash / self-pay est.
$77–$145
~80–150% of Medicare

Your ZIP in New Hampshire

Check your ZIP for local context, whether you are in Manchester, Nashua, Concord, the Seacoast around Portsmouth, the Lakes Region, or the North Country.

What office visit (established, moderate) costs at hospitals near you

Everything above is a national average. The hospital you pick in New Hampshire moves the bill more than anything else you control.

Locked

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 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 New Hampshire the office and hospital physician lines for this CPT differ by $39.29.

National vs New Hampshire

National office$95.19
National hospital (physician)$57.45
New Hampshire vs nationalwithin 2% of the national office rate of $95.19

Where New Hampshire ranks for this CPT

Rank (lowest physician fee first)#38 of 51
Lowest stateArkansas ($86.86)
Highest stateAlaska ($118.72)

Office Visit (Established, Moderate) and how New Hampshire is priced

New Hampshire is priced as one statewide locality with geographic indices above the national average, keeping company with its high-cost New England neighbors. From Nashua to the North Country, the fee schedule applies identical adjustments, even though the southern tier is economically an extension of greater Boston. CMS has never split the state, so the Massachusetts border is also a pricing border: cross it southbound and the metro Boston locality takes over. That makes New Hampshire a clear example of how locality lines, not just providers, shape what Medicare approves.

Southern New Hampshire residents routinely use Boston hospitals for complex care, accepting metro pricing in exchange for academic-center depth, while the state's own tertiary referral center sits in the west near the Vermont border. The Lakes Region and North Country rely on small rural hospitals with limited procedure menus. No state income or sales tax attracts retirees, steadily raising Medicare demand.

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?

Office Visit (Established, Moderate) in New Hampshire: questions

New Hampshire is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99213 is $96.82 in an office and $57.53 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.

Not on the physician fee schedule. New Hampshire uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.

After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $19 for the office physician line or $12 for the hospital physician line in New Hampshire. Medigap may cover that 20%. This is not the hospital facility fee.

No. $96.82 is the Medicare physician allowed amount for CPT 99213. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. New Hampshire ranks #38 of 51 states on this physician line (within 2% of the national office rate of $95.19).

Data source: 2026 Medicare Physician Fee Schedule (CMS PPRRVU26B, released March 2026). Conversion factor: $33.4009. Prices shown are Medicare allowed amounts for the physician service and may not match what you are billed. Private insurance and self-pay ranges, when shown, are labeled estimates (typical multiples of Medicare), not quotes. This site is an independent cost tool, not medical advice.