CPT 99205 Evaluation & Management
Office o/p new hi 60 min Cost
Body System: General
Medicare Facility Rate
$160
CMS PFS CY2026
Medicare Non-Facility Rate
$237
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
3.50
Work RVU
0.94
Facility PE RVU
0.36
Malpractice RVU
7.09
Total RVU
Frequently Asked Questions
How much does Office o/p new hi 60 min cost?
The Medicare facility rate is $160. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Office o/p new hi 60 min cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $160.