Office Visit (Established, High) Cost in Texas
Office o/p est hi 40 min
$190.98Texas 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
Texas Medicare physician rate (2026)
-0.7% vs nationalAverage of 8 localities. Office range $183.62–$197.10.
Your ZIP in Texas
With so many Texas localities, check your exact ZIP: Houston, Dallas-Fort Worth, Austin, the Galveston and Beaumont coast, San Antonio, El Paso, the Valley, and rural West Texas can all price differently.
What office visit (established, high) costs at hospitals near you
Everything above is a national average. The hospital you pick in Texas 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 Texas the office and hospital physician lines for this CPT differ by $65.77.
National vs Texas
Where Texas ranks for this CPT
CPT 99215 by Texas locality
| Locality | Office |
|---|---|
| austin | $197.10 |
| houston | $195.13 |
| dallas | $191.87 |
| galveston | $191.29 |
| fort worth | $191.04 |
| brazoria | $190.77 |
| rest of texas | $187.02 |
| beaumont | $183.62 |
PE GPCI ranges from 0.910 to 1.058 in Texas. That index is why the same CPT is not one price statewide.
Office Visit (Established, High) and how Texas is priced
Texas is carved into grouped metro localities rather than priced statewide: Houston, Dallas, Fort Worth, Austin, Galveston, Beaumont, and Brazoria each carry their own locality, and the enormous remainder of the state shares rest-of-state pricing. The big-city localities approve higher amounts than rural Texas, with Houston and Dallas at the top of the state's range. Uniquely, several smaller Gulf Coast areas kept their own localities from an earlier era, which is why Galveston and Beaumont are priced separately from Houston. San Antonio and El Paso, despite their size, fall under rest-of-state factors.
Texas contains several of the largest medical complexes in the world, most famously in Houston, plus deep hospital markets in Dallas-Fort Worth, San Antonio, and Austin. At the other extreme, West Texas and the Panhandle include counties with no physician at all, and rural hospital closures have hit Texas harder than almost any state. Border communities from El Paso to the Rio Grande Valley have distinct markets, and some residents cross into Mexico for lower-cost dental and pharmacy care.
This procedure: This is the highest established-patient office visit level, for encounters involving high-complexity decisions: severe worsening of a chronic illness, problems that threaten life or bodily function, or decisions about hospitalization, major surgery, or high-risk drug therapy requiring intensive monitoring. Billed by time it means 40 to 54 minutes on the visit date. It is far less common than levels three and four, appearing when something significant is genuinely happening with your health.
What Is Office Visit (Established, High)?
This is the highest established-patient office visit level, for encounters involving high-complexity decisions: severe worsening of a chronic illness, problems that threaten life or bodily function, or decisions about hospitalization, major surgery, or high-risk drug therapy requiring intensive monitoring. Billed by time it means 40 to 54 minutes on the visit date. It is far less common than levels three and four, appearing when something significant is genuinely happening with your health.
What Affects the Cost
- –It carries the highest established-visit price, and visits at this level usually sit inside expensive care episodes: imminent hospitalizations, treatment escalations, or complex disease flares.
- –The decisions made here, starting high-risk medications, ordering urgent advanced imaging, arranging admission, each open substantial separate spending.
- –Prolonged-service add-on codes attach beyond 54 minutes, extending charges.
- –Specialist and academic-center billing at this level exceeds primary care rates.
- –Facility fees apply as always in hospital-owned settings, proportionally largest on the biggest visit codes.
Questions to Ask Before Booking
- 1.What made today a level-five visit, and what is that price under my plan?
- 2.Which of the urgent next steps you are ordering need authorization, and who handles the expedited requests?
- 3.If admission is possible, does my plan require notification, and will you handle it?
- 4.Are prolonged-service charges being added for today's visit length?
- 5.Does my plan offer care management support that could cover some of this follow-up at no cost?
Other featured procedures in Texas
Office Visit (Established, High) in other states
Office Visit (Established, High) in Texas: questions
The 2026 Medicare physician office rate for CPT 99215 averages $190.98 across 8 Texas localities, from $183.62 in BEAUMONT to $197.10 in AUSTIN. The hospital physician rate averages $125.21. Enter a ZIP for the exact locality.
Yes. CMS splits Texas into 8 payment localities. For this CPT the office physician fee spans $13.48 from the lowest to highest locality. With so many Texas localities, check your exact ZIP: Houston, Dallas-Fort Worth, Austin, the Galveston and Beaumont coast, San Antonio, El Paso, the Valley, and rural West Texas can all price differently.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $38 for the office physician line or $25 for the hospital physician line in Texas. Medigap may cover that 20%. This is not the hospital facility fee.
No. $190.98 is the Medicare physician allowed amount for CPT 99215. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Texas ranks #31 of 51 states on this physician line (within 2% of the national office rate of $192.39).