Office Visit (New, High) Cost in South Dakota
Office o/p new hi 60 min
$228.83South Dakota 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
South Dakota Medicare physician rate (2026)
-3.4% vs nationalSingle statewide locality.
Your ZIP in South Dakota
Try a ZIP lookup for your area, whether Sioux Falls, Rapid City and the Black Hills, Aberdeen, Pierre, or the reservation and ranch country in between.
What office visit (new, high) costs at hospitals near you
Everything above is a national average. The hospital you pick in South Dakota 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 South Dakota the office and hospital physician lines for this CPT differ by $76.49.
National vs South Dakota
Where South Dakota ranks for this CPT
Office Visit (New, High) and how South Dakota is priced
All of South Dakota falls under a single payment locality with indices near the bottom of the national scale, cushioned by the work index floor for low-cost states. Sioux Falls and a West River ranch community share one published fee schedule. The state's east-west split, with most people and providers east of the Missouri River, has no counterpart in the pricing structure. That leaves South Dakota with some of the simplest and lowest Medicare pricing in the country.
Sioux Falls has become a genuine regional medical hub, headquarters to large systems whose reach extends across the Dakotas and into neighboring states, while Rapid City anchors care for the West River side and the Black Hills. Vast stretches between them rely on critical access hospitals and tribal facilities, some of the most isolated care settings in America. Referrals to Sioux Falls, Rapid City, or out of state are a routine part of rural care.
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 South Dakota
Office Visit (New, High) in other states
Office Visit (New, High) in South Dakota: questions
South Dakota is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99205 is $228.83 in an office and $152.34 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. South Dakota 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 $46 for the office physician line or $30 for the hospital physician line in South Dakota. Medigap may cover that 20%. This is not the hospital facility fee.
No. $228.83 is the Medicare physician allowed amount for CPT 99205. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. South Dakota ranks #20 of 51 states on this physician line (3% below the national office rate of $236.81).