CPT 99214 Evaluation & Management
Office visit - established patient, moderate complexity Cost
Body System: General
Medicare Facility Rate
$98
CMS PFS CY2026
Medicare Non-Facility Rate
$145
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.92
Work RVU
0.93
Facility PE RVU
0.17
Malpractice RVU
Cost by Location
| 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 |
Frequently Asked Questions
How much does Office visit - established patient, moderate complexity cost?
The Medicare facility rate is $98. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Office visit - established patient, moderate complexity 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 $98.