Office Visit (Established, Moderate) Cost in New York
Office o/p est low 20 min
$103.97New York physician fee2026 Medicare office rate- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
New York Medicare physician rate (2026)
+9.2% vs nationalAverage of 5 localities. Office range $91.86–$109.76.
Your ZIP in New York
New York's multiple localities make a ZIP-level check essential: compare Manhattan, Queens and the outer boroughs, Long Island, the Hudson Valley near Poughkeepsie, and upstate cities like Buffalo, Rochester, Syracuse, and Albany.
What office visit (established, moderate) costs at hospitals near you
Everything above is a national average. The hospital you pick in New York 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.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
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 York the office and hospital physician lines for this CPT differ by $42.11.
National vs New York
Where New York ranks for this CPT
CPT 99213 by New York locality
| Locality | Office |
|---|---|
| nyc suburbs/long island | $109.76 |
| queens | $108.18 |
| manhattan | $107.63 |
| poughkpsie/n nyc suburbs | $102.41 |
| rest of new york | $91.86 |
PE GPCI ranges from 0.950 to 1.189 in New York. That index is why the same CPT is not one price statewide.
Office Visit (Established, Moderate) and how New York is priced
New York has one of the most complex locality maps in the country, with around five payment areas: Manhattan is its own locality, Queens is separately priced, the NYC suburbs and Long Island form another high-cost locality, the Poughkeepsie area has its own, and the rest of the state, including Buffalo, Rochester, Syracuse, and Albany, shares a distinctly lower-priced upstate locality. The spread between Manhattan and upstate adjustments is among the widest within any state. A knee MRI or office visit is approved at meaningfully different amounts in Manhattan, Mineola, and Rochester. Upstate New York prices closer to the Midwest than to the five boroughs.
New York City is a global medical capital with world-famous academic medical centers competing within blocks of each other, while upstate cities each center on their own regional academic hubs. Long Island and the lower Hudson Valley support dense suburban hospital markets of their own. The upstate-downstate divide runs through everything in New York health care, including what providers charge and what patients can access locally.
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?
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Office Visit (Established, Moderate) in other states
Office Visit (Established, Moderate) in New York: questions
The 2026 Medicare physician office rate for CPT 99213 averages $103.97 across 5 New York localities, from $91.86 in REST OF NEW YORK to $109.76 in NYC SUBURBS/LONG ISLAND. The hospital physician rate averages $61.86. Enter a ZIP for the exact locality.
Yes. CMS splits New York into 5 payment localities. For this CPT the office physician fee spans $17.90 from the lowest to highest locality. New York's multiple localities make a ZIP-level check essential: compare Manhattan, Queens and the outer boroughs, Long Island, the Hudson Valley near Poughkeepsie, and upstate cities like Buffalo, Rochester, Syracuse, and Albany.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $21 for the office physician line or $12 for the hospital physician line in New York. Medigap may cover that 20%. This is not the hospital facility fee.
No. $103.97 is the Medicare physician allowed amount for CPT 99213. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. New York ranks #48 of 51 states on this physician line (9% above the national office rate of $95.19).