Office Visit (Established, Moderate) Cost in Washington
Office o/p est low 20 min
$102.75Washington 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
Washington Medicare physician rate (2026)
+7.9% vs nationalAverage of 2 localities. Office range $97.62–$107.88.
Your ZIP in Washington
Enter your ZIP code to see whether Seattle-area or rest-of-state pricing applies, from Seattle, Tacoma, and Everett to Spokane, the Tri-Cities, Vancouver, Bellingham, and the Olympic Peninsula.
What office visit (established, moderate) costs at hospitals near you
Everything above is a national average. The hospital you pick in Washington 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 Washington the office and hospital physician lines for this CPT differ by $43.02.
National vs Washington
Where Washington ranks for this CPT
CPT 99213 by Washington locality
| Locality | Office |
|---|---|
| seattle (king cnty) | $107.88 |
| rest of washington | $97.62 |
PE GPCI ranges from 1.053 to 1.227 in Washington. That index is why the same CPT is not one price statewide.
Office Visit (Established, Moderate) and how Washington is priced
Washington divides into a Seattle-area locality and a rest-of-state locality, so Puget Sound's biggest market carries higher geographic adjustments than Spokane, the Tri-Cities, or the coast. The Seattle locality reflects some of the highest wages in the western United States, while everywhere else in the state shares one lower-cost set of factors. An identical procedure is therefore approved at more in Seattle than in Spokane, a two-tier pattern much like Oregon's. Rest-of-state Washington still prices respectably against national averages.
Seattle is the referral capital of the Pacific Northwest, with academic medicine that serves not just Washington but Alaska, Montana, Idaho, and Wyoming through long-standing regional arrangements. Spokane anchors the Inland Northwest, drawing patients from northern Idaho and beyond, while the Olympic Peninsula and southwest coast are comparatively underserved. Rapid consolidation has concentrated much of the state's care into a few large systems.
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?
Other featured procedures in Washington
Office Visit (Established, Moderate) in other states
Office Visit (Established, Moderate) in Washington: questions
The 2026 Medicare physician office rate for CPT 99213 averages $102.75 across 2 Washington localities, from $97.62 in REST OF WASHINGTON to $107.88 in SEATTLE (KING CNTY). The hospital physician rate averages $59.73. Enter a ZIP for the exact locality.
Yes. CMS splits Washington into 2 payment localities. For this CPT the office physician fee spans $10.26 from the lowest to highest locality. Enter your ZIP code to see whether Seattle-area or rest-of-state pricing applies, from Seattle, Tacoma, and Everett to Spokane, the Tri-Cities, Vancouver, Bellingham, and the Olympic Peninsula.
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 Washington. Medigap may cover that 20%. This is not the hospital facility fee.
No. $102.75 is the Medicare physician allowed amount for CPT 99213. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Washington ranks #46 of 51 states on this physician line (8% above the national office rate of $95.19).