Office Visit (Established, Moderate-High) Cost in Tennessee
Office o/p est mod 30 min
$127.36Tennessee 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
Tennessee Medicare physician rate (2026)
-6.1% vs nationalSingle statewide locality.
Your ZIP in Tennessee
Enter a ZIP code for your part of Tennessee, whether Nashville, Memphis, Knoxville, Chattanooga, the Tri-Cities, or the rural plateau and delta counties.
What office visit (established, moderate-high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Tennessee 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 Tennessee the office and hospital physician lines for this CPT differ by $46.45.
National vs Tennessee
Where Tennessee ranks for this CPT
Office Visit (Established, Moderate-High) and how Tennessee is priced
Tennessee's Medicare rates come from one statewide locality with below-average geographic indices, so Memphis, Nashville, Knoxville, and Chattanooga all publish the same approved amounts despite being four distinct metro markets. The uniform locality stretches across a state that spans two time zones and several regional economies. Nashville's boom has raised local practice costs faster than the statewide averages that feed the indices. For patients, the fee schedule is identical statewide; the markets around it are anything but.
Nashville is the corporate capital of American hospital operations, home to major for-profit chains, alongside a prominent academic medical center, while Memphis anchors care for the Mid-South including parts of Mississippi and Arkansas. Knoxville and Chattanooga serve East Tennessee, and the rural Cumberland Plateau and West Tennessee counties have seen multiple hospital closures. Cross-border patient flows into Tennessee's metros are heavy from every neighboring state.
This procedure: This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Is Office Visit (Established, Moderate-High)?
This is an established-patient office visit of moderate complexity, a step above the routine check-in: managing multiple chronic conditions at once, adjusting medications with real risk, or evaluating a new problem that needs a workup. Billed by time it represents 30 to 39 minutes on the visit date. Over the last decade it has overtaken the level-three visit as the most common established-patient code in primary care, reflecting more complex visits and better documentation.
What Affects the Cost
- –It reimburses meaningfully more than 99213, and which of the two your visit becomes depends on documented complexity you cannot see from the waiting room.
- –Multi-condition patients land here repeatedly through the year, compounding the higher per-visit rate.
- –Facility fees at hospital-owned practices add a second charge to every visit at any level.
- –In-office tests, injections, or procedures stack as separate lines.
- –Specialist follow-ups at this level are priced above primary care equivalents in most charge masters.
Questions to Ask Before Booking
- 1.What determines whether my visit bills as level three or four, and what is the price difference for me?
- 2.During my deductible phase, what is the negotiated rate for this level here?
- 3.Will medication changes today push the visit to a higher level?
- 4.Are any of today's services billed separately from the visit code?
- 5.Can complex medication reviews be split across telehealth check-ins at lower cost?
Other featured procedures in Tennessee
Office Visit (Established, Moderate-High) in other states
Office Visit (Established, Moderate-High) in Tennessee: questions
Tennessee is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 99214 is $127.36 in an office and $80.91 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. Tennessee 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 $25 for the office physician line or $16 for the hospital physician line in Tennessee. Medigap may cover that 20%. This is not the hospital facility fee.
No. $127.36 is the Medicare physician allowed amount for CPT 99214. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Tennessee ranks #6 of 51 states on this physician line (6% below the national office rate of $135.61).