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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. 99215
  4. Cost Analysis

How Much Does Established patient office or other outpatient, visit typically 40 minutes Cost on Medicare?

Cost analysis for CPT 99215 — Established patient office or other outpatient, visit typically 40 minutes

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Average Medicare Payment

$117.52

2023 data

Total Payments (2023)

$1.3B

Services (2023)

11.1M

Price Change (2014–2023)

+20.3%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$97.65$856.3M8.6M—
2015$98.81$877.0M8.7M+1.2%
2016$96.61$891.6M9.1M-2.2%
2017$96.18$902.5M9.2M-0.4%
2018$96.59$928.4M9.4M+0.4%
2019$97.95$958.5M9.6M+1.4%
2020$97.91$786.3M7.8M-0.0%
2021$124.55$1.3B9.9M+27.2%
2022$120.50$1.3B10.3M-3.3%
2023$117.52$1.3B11.1M-2.5%

🗺️ State-by-State Cost Variation

The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $149.59 vs ND at $97.98.

StateAvg PaymentTotal PaymentsServicesProviders
AK$149.59$4.4M29.2K398
NY$137.01$83.9M612.5K8.3K
NJ$136.69$45.0M329.0K3.7K
DC$133.65$8.1M60.5K656
CA$133.65$220.6M1.7M15.4K
CT$128.07$12.3M96.3K1.8K
FL$125.25$91.2M727.8K8.5K
IL$123.54$63.0M510.2K6.2K
DE$123.14$6.3M51.0K569
MD$122.81$44.2M360.3K4.1K
HI$121.83$4.2M34.4K375
MA$121.58$56.7M466.7K6.4K
NV$121.33$9.7M79.7K792
WY$120.46$1.9M15.4K222
VA$119.63$38.4M320.7K4.0K
VI$119.24$614.2K5.2K31
GA$119.21$25.2M211.1K3.3K
AZ$118.85$38.8M326.3K3.3K
WA$118.49$36.1M304.7K4.3K
TX$118.39$80.6M680.9K8.7K
GU$117.71$277.2K2.4K19
PA$117.52$61.6M524.4K7.2K
SC$116.33$21.9M188.0K2.4K
AE$114.48$41.2K3606
MN$114.46$23.8M208.2K4.1K
IN$113.16$19.3M170.7K2.7K
LA$112.82$13.9M123.0K1.6K
AL$112.40$13.8M123.1K1.7K
NC$111.85$43.9M392.2K5.7K
ZZ$111.69$20.2K1816
TN$111.16$22.5M202.1K2.7K
CO$111.12$26.1M234.9K3.2K
NH$110.90$7.3M66.2K1.1K
MI$110.67$26.4M238.9K4.4K
NM$110.61$7.5M67.9K958
KY$110.36$9.1M82.3K1.4K
XX$110.19$53.1K4824
MO$109.96$15.5M141.2K2.3K
PR$109.25$312.3K2.9K52
MS$109.04$8.1M74.6K900
RI$108.47$2.6M24.2K463
UT$107.34$8.9M83.1K1.2K
OH$107.04$29.5M275.3K5.0K
OK$106.76$10.8M100.8K1.3K
WV$106.31$3.2M29.9K467
AR$105.76$7.4M70.2K874
OR$105.67$14.5M137.6K2.2K
WI$105.65$21.0M198.8K3.3K
NE$105.42$6.4M60.8K915
VT$105.40$2.9M28.0K409
IA$104.86$7.8M74.5K1.2K

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Ian PurcellNeurologyCA$622.1K4.3K$144.71
Mark ScholzHematology-OncologyCA$593.6K4.1K$145.97
Stuart HetrickNeurologyAZ$569.4K4.5K$125.44
William CraigCardiologyTX$480.5K3.9K$123.78
Spyros MezitisEndocrinologyNY$454.9K3.0K$150.23
Jeffrey MaceCardiologyCA$450.9K3.1K$144.89
Criselda Abad-SantosPsychiatryCA$446.5K3.1K$141.74
Jayesh MehtaHematologyIL$438.1K3.0K$146.12
Nikan KhatibiAnesthesiologyCA$429.1K3.1K$138.96
Andrew WongInternal MedicineMD$421.6K2.7K$155.56
Sandeep ThakkarNeurologyCA$421.3K3.2K$132.20
Jay SchapiraCardiologyCA$349.6K2.5K$140.25
Pingfeng DuCardiologyCA$346.3K2.6K$131.42
Constantin DasanuHematology-OncologyCA$339.2K3.1K$111.11
Philip NgaiOphthalmologyCA$325.6K2.2K$149.15
Yousef KhelfaInternal MedicineCA$323.8K2.9K$110.13
Purba BiswasInternal MedicineAZ$315.5K2.5K$125.40
William ChowNeurologyCA$310.4K2.1K$148.67
Leo PolosajianCardiologyCA$295.5K1.9K$153.33
Grace KimEndocrinologyCA$291.6K1.9K$153.21

🤔 Is Established patient office or other outpatient, visit typically 40 minutes Overpriced?

Based on the data, CPT 99215 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.

Costs have increased 20.3% 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.