How Much Does Established Patient Office Visit - Moderate Complexity Cost?
Also known as: Office visit - established patient, moderate complexity (CPT 99214)
A longer follow-up visit for a condition that needs more detailed evaluation or management.
Established Patient Office Visit - Moderate Complexity (CPT 99214) costs $98 at Medicare rates.
Patient Guide: Established Patient Office Visit - Moderate Complexity
What you need to know before your appointment
What to Expect
The doctor will spend extra time reviewing your condition, may order additional tests, and will discuss adjustments to your treatment plan.
How Long Does It Take?
25-35 minutes
Common Reasons Doctors Order This
Worsening condition, chronic disease management, multiple health issues, pre-procedure evaluation
How to Prepare
Prepare a detailed list of symptoms with timing. Bring recent test results and notes from other doctors.
Procedures Commonly Done Together
These procedures are frequently performed alongside Office visit - established patient, moderate complexity
Office visit - established patient, moderate complexity Cost by Location
Medicare-adjusted rates across CMS localities
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA* | $132 | $199 — $331 |
| AL — ALABAMA | $95 | $142 — $236 |
| AR — ARKANSAS | $94 | $141 — $234 |
| AZ — ARIZONA | $99 | $149 — $248 |
| AZ — Phoenix | $100 | $150 — $250 |
| CA — BAKERSFIELD | $103 | $154 — $257 |
| CA — CHICO | $102 | $153 — $256 |
| CA — EL CENTRO | $102 | $154 — $256 |
| CA — FRESNO | $102 | $153 — $256 |
| CA — HANFORD-CORCORAN | $102 | $153 — $256 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $107 | $161 — $268 |
| CA — Los Angeles | $109 | $163 — $271 |
| CA — MADERA | $102 | $153 — $256 |
| CA — MERCED | $102 | $153 — $256 |
| CA — MODESTO | $102 | $153 — $256 |
| CA — NAPA | $112 | $168 — $280 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $106 | $159 — $265 |
| CA — REDDING | $102 | $153 — $256 |
| CA — REST OF CALIFORNIA | $102 | $153 — $256 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $104 | $156 — $260 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $106 | $158 — $264 |
| CA — SALINAS | $105 | $158 — $263 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $106 | $159 — $266 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $117 | $175 — $292 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | $118 | $177 — $296 |
What Insurance Companies Actually Pay
Real negotiated rates from 9 hospitals across 5 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $212 | $31 - $386 | 6 |
| Cigna | $237 | $67 - $468 | 6 |
| United | $134 | $22 - $329 | 4 |
| BCBS-TX | $189 | $117 - $254 | 3 |
| Kaiser | $94 | $21 - $190 | 2 |
| Multiplan | $330 | $73 - $658 | 3 |
| CHC | $173 | $45 - $265 | 2 |
| Humana | $231 | $76 - $313 | 3 |
| BCBS | $234 | $187 - $258 | 1 |
| Peach State | $125 | $56 - $241 | 2 |
| BCBS - Anthem | $195 | $79 - $269 | 1 |
| OPTUM | $234 | $130 - $398 | 1 |
How to Reduce Your Cost for Office visit - established patient, moderate complexity
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($145) differs from the facility rate ($98). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Medicare rates for this procedure range from $80 to $132 depending on location. Commercial rates vary even more.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU () x CF ($33.40) = N/A
Related Procedures
Similar procedures in the same category or body system
Consider These Alternatives
Depending on your clinical situation, these alternatives may be appropriate and could save you money.
Note: Alternative procedures may not be clinically appropriate for all patients. Always consult your physician to determine the best option for your specific situation.
Frequently Asked Questions
How much does Office visit - established patient, moderate complexity cost?
The Medicare facility rate for Office visit - established patient, moderate complexity is $98. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Office visit - established patient, moderate complexity cost without insurance?
Without insurance, the cost of Office visit - established patient, moderate complexity can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Office visit - established patient, moderate complexity?
Most commercial health insurance plans and Medicare cover Office visit - established patient, moderate complexity when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.