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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. 99204
  4. Cost Analysis

How Much Does New patient office or other outpatient visit, typically 45 minutes Cost on Medicare?

Cost analysis for CPT 99204 — New patient office or other outpatient visit, typically 45 minutes

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Average Medicare Payment

$109.27

2023 data

Total Payments (2023)

$1.3B

Services (2023)

11.4M

Price Change (2014–2023)

-3.8%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$113.64$966.0M8.4M—
2015$112.98$1.0B8.7M-0.6%
2016$110.32$1.0B9.2M-2.4%
2017$108.97$1.0B9.3M-1.2%
2018$109.64$1.1B9.5M+0.6%
2019$110.72$1.1B9.8M+1.0%
2020$110.52$879.5M7.8M-0.2%
2021$115.99$1.3B10.9M+4.9%
2022$111.77$1.3B11.2M-3.6%
2023$109.27$1.3B11.4M-2.2%

🗺️ State-by-State Cost Variation

The most expensive state pays 1.4x more than the cheapest for this procedure. AK averages $136.69 vs VT at $96.19.

StateAvg PaymentTotal PaymentsServicesProviders
AK$136.69$2.8M20.4K459
NY$131.98$92.9M703.8K14.2K
NJ$127.67$46.7M365.7K7.2K
DC$125.45$4.3M34.0K665
CA$122.57$139.4M1.1M19.4K
XX$122.27$19.8K1627
MD$121.16$39.2M323.2K5.4K
CT$119.77$12.1M101.0K2.7K
MA$116.11$33.0M283.9K5.9K
RI$114.86$3.4M29.4K740
IL$114.48$47.7M416.6K8.6K
FL$114.39$133.3M1.2M19.0K
PR$113.28$532.2K4.7K199
CO$112.29$17.1M152.3K3.7K
PA$112.02$51.3M457.9K10.3K
DE$111.97$6.2M54.9K953
HI$111.46$3.3M29.8K628
VA$110.98$40.6M366.0K6.8K
NV$110.18$11.6M105.5K2.0K
GU$110.12$301.2K2.7K45
WA$109.91$24.7M225.1K4.8K
TX$109.79$90.9M828.1K16.4K
MN$109.42$12.1M110.3K3.3K
GA$109.05$37.0M339.6K7.3K
MI$108.19$26.7M246.6K6.3K
AZ$107.61$38.6M358.8K5.8K
AE$107.59$63.0K58611
WY$106.48$1.7M15.8K339
OR$106.02$12.2M115.1K2.7K
SC$105.54$28.8M273.1K4.5K
LA$105.21$15.5M147.1K3.2K
NH$105.06$6.2M58.7K1.3K
MO$104.93$20.9M199.4K4.4K
NC$104.65$40.8M389.6K8.4K
UT$104.54$7.4M70.7K1.8K
OK$104.37$16.1M154.7K2.8K
IN$104.07$23.1M221.8K4.7K
OH$103.80$36.5M351.9K8.3K
AL$103.61$17.8M172.2K3.7K
MT$103.34$3.7M36.2K782
KS$103.11$11.6M112.9K1.9K
KY$103.05$15.4M149.2K3.2K
TN$102.78$28.8M280.7K5.5K
WI$102.54$12.4M121.3K3.4K
NE$101.93$7.0M68.8K1.3K
ZZ$101.40$43.8K4329
IA$101.15$9.3M92.4K1.9K
MS$100.75$12.6M124.9K2.2K
AP$100.35$35.3K35210
AR$100.16$11.3M113.1K2.1K
NM$99.86$5.5M55.1K1.2K

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Adam MoskowitzGastroenterologyNY$203.4K1.9K$107.44
Michael PateteOtolaryngologyFL$179.0K1.5K$118.45
Vladimir SkorokhodEmergency MedicineCA$178.3K1.2K$154.90
David HairOphthalmologyCA$177.0K1.5K$116.74
Jamie DevitoDermatologyCA$131.5K967$136.02
Jay HaynieOptometryWA$125.3K1.0K$119.87
David BoesOphthalmologyMT$123.5K1.0K$120.62
Elizabeth KavalerUrologyNY$111.7K806$138.60
Rami SartawiInterventional RadiologyNY$110.2K740$148.93
Jennie YuInternal MedicineNY$110.1K769$143.17
Rona SilkissOphthalmologyCA$106.9K742$144.11
Michael BublikOtolaryngologyCA$103.8K731$142.04
Bernard DuranteOtolaryngologyMA$102.2K826$123.67
Anish KokaCardiologyPA$102.1K797$128.10
Krikor TatoyanInternal MedicineCA$100.5K726$138.47
Wesley HollomonInternal MedicineNY$100.2K690$145.24
Todd LindquistOtolaryngologyFL$98.1K816$120.22
Min WuFamily PracticeCA$97.8K731$133.80
Michael MilliganSports MedicineFL$97.6K747$130.71
Wayne ShaiaOtolaryngologyVA$97.5K807$120.80

🤔 Is New patient office or other outpatient visit, typically 45 minutes Overpriced?

Based on the data, CPT 99204 shows a 1.4x variation in pricing across states — relatively consistent by Medicare standards.

Costs have decreased 3.8% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.

This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.