Cost analysis for CPT 99204 — New patient office or other outpatient visit, typically 45 minutes
Average Medicare Payment
$109.27
2023 data
Total Payments (2023)
$1.3B
Services (2023)
11.4M
Price Change (2014–2023)
-3.8%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $113.64 | $966.0M | 8.4M | — |
| 2015 | $112.98 | $1.0B | 8.7M | -0.6% |
| 2016 | $110.32 | $1.0B | 9.2M | -2.4% |
| 2017 | $108.97 | $1.0B | 9.3M | -1.2% |
| 2018 | $109.64 | $1.1B | 9.5M | +0.6% |
| 2019 | $110.72 | $1.1B | 9.8M | +1.0% |
| 2020 | $110.52 | $879.5M | 7.8M | -0.2% |
| 2021 | $115.99 | $1.3B | 10.9M | +4.9% |
| 2022 | $111.77 | $1.3B | 11.2M | -3.6% |
| 2023 | $109.27 | $1.3B | 11.4M | -2.2% |
The most expensive state pays 1.4x more than the cheapest for this procedure. AK averages $136.69 vs VT at $96.19.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $136.69 | $2.8M | 20.4K | 459 |
| NY | $131.98 | $92.9M | 703.8K | 14.2K |
| NJ | $127.67 | $46.7M | 365.7K | 7.2K |
| DC | $125.45 | $4.3M | 34.0K | 665 |
| CA | $122.57 | $139.4M | 1.1M | 19.4K |
| XX | $122.27 | $19.8K | 162 | 7 |
| MD | $121.16 | $39.2M | 323.2K | 5.4K |
| CT | $119.77 | $12.1M | 101.0K | 2.7K |
| MA | $116.11 | $33.0M | 283.9K | 5.9K |
| RI | $114.86 | $3.4M | 29.4K | 740 |
| IL | $114.48 | $47.7M | 416.6K | 8.6K |
| FL | $114.39 | $133.3M | 1.2M | 19.0K |
| PR | $113.28 | $532.2K | 4.7K | 199 |
| CO | $112.29 | $17.1M | 152.3K | 3.7K |
| PA | $112.02 | $51.3M | 457.9K | 10.3K |
| DE | $111.97 | $6.2M | 54.9K | 953 |
| HI | $111.46 | $3.3M | 29.8K | 628 |
| VA | $110.98 | $40.6M | 366.0K | 6.8K |
| NV | $110.18 | $11.6M | 105.5K | 2.0K |
| GU | $110.12 | $301.2K | 2.7K | 45 |
| WA | $109.91 | $24.7M | 225.1K | 4.8K |
| TX | $109.79 | $90.9M | 828.1K | 16.4K |
| MN | $109.42 | $12.1M | 110.3K | 3.3K |
| GA | $109.05 | $37.0M | 339.6K | 7.3K |
| MI | $108.19 | $26.7M | 246.6K | 6.3K |
| AZ | $107.61 | $38.6M | 358.8K | 5.8K |
| AE | $107.59 | $63.0K | 586 | 11 |
| WY | $106.48 | $1.7M | 15.8K | 339 |
| OR | $106.02 | $12.2M | 115.1K | 2.7K |
| SC | $105.54 | $28.8M | 273.1K | 4.5K |
| LA | $105.21 | $15.5M | 147.1K | 3.2K |
| NH | $105.06 | $6.2M | 58.7K | 1.3K |
| MO | $104.93 | $20.9M | 199.4K | 4.4K |
| NC | $104.65 | $40.8M | 389.6K | 8.4K |
| UT | $104.54 | $7.4M | 70.7K | 1.8K |
| OK | $104.37 | $16.1M | 154.7K | 2.8K |
| IN | $104.07 | $23.1M | 221.8K | 4.7K |
| OH | $103.80 | $36.5M | 351.9K | 8.3K |
| AL | $103.61 | $17.8M | 172.2K | 3.7K |
| MT | $103.34 | $3.7M | 36.2K | 782 |
| KS | $103.11 | $11.6M | 112.9K | 1.9K |
| KY | $103.05 | $15.4M | 149.2K | 3.2K |
| TN | $102.78 | $28.8M | 280.7K | 5.5K |
| WI | $102.54 | $12.4M | 121.3K | 3.4K |
| NE | $101.93 | $7.0M | 68.8K | 1.3K |
| ZZ | $101.40 | $43.8K | 432 | 9 |
| IA | $101.15 | $9.3M | 92.4K | 1.9K |
| MS | $100.75 | $12.6M | 124.9K | 2.2K |
| AP | $100.35 | $35.3K | 352 | 10 |
| AR | $100.16 | $11.3M | 113.1K | 2.1K |
| NM | $99.86 | $5.5M | 55.1K | 1.2K |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Adam Moskowitz | Gastroenterology | NY | $203.4K | 1.9K | $107.44 |
| Michael Patete | Otolaryngology | FL | $179.0K | 1.5K | $118.45 |
| Vladimir Skorokhod | Emergency Medicine | CA | $178.3K | 1.2K | $154.90 |
| David Hair | Ophthalmology | CA | $177.0K | 1.5K | $116.74 |
| Jamie Devito | Dermatology | CA | $131.5K | 967 | $136.02 |
| Jay Haynie | Optometry | WA | $125.3K | 1.0K | $119.87 |
| David Boes | Ophthalmology | MT | $123.5K | 1.0K | $120.62 |
| Elizabeth Kavaler | Urology | NY | $111.7K | 806 | $138.60 |
| Rami Sartawi | Interventional Radiology | NY | $110.2K | 740 | $148.93 |
| Jennie Yu | Internal Medicine | NY | $110.1K | 769 | $143.17 |
| Rona Silkiss | Ophthalmology | CA | $106.9K | 742 | $144.11 |
| Michael Bublik | Otolaryngology | CA | $103.8K | 731 | $142.04 |
| Bernard Durante | Otolaryngology | MA | $102.2K | 826 | $123.67 |
| Anish Koka | Cardiology | PA | $102.1K | 797 | $128.10 |
| Krikor Tatoyan | Internal Medicine | CA | $100.5K | 726 | $138.47 |
| Wesley Hollomon | Internal Medicine | NY | $100.2K | 690 | $145.24 |
| Todd Lindquist | Otolaryngology | FL | $98.1K | 816 | $120.22 |
| Min Wu | Family Practice | CA | $97.8K | 731 | $133.80 |
| Michael Milligan | Sports Medicine | FL | $97.6K | 747 | $130.71 |
| Wayne Shaia | Otolaryngology | VA | $97.5K | 807 | $120.80 |
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.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.