CPT 99215 Evaluation & Management
Office visit - established patient, high complexity Cost
Body System: General
Medicare Facility Rate
$139
CMS PFS CY2026
Medicare Non-Facility Rate
$201
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
2.80
Work RVU
1.25
Facility PE RVU
0.26
Malpractice RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| US — Carrier 01112 Locality 05 | $141 | $212 — $354 |
| US — Carrier 01112 Locality 09 | $143 | $215 — $359 |
| US — Carrier 01112 Locality 51 | $137 | $205 — $342 |
| US — Carrier 01112 Locality 52 | $142 | $212 — $354 |
| US — Carrier 01112 Locality 53 | $136 | $205 — $341 |
| US — Carrier 01112 Locality 54 | $128 | $191 — $319 |
| US — Carrier 01112 Locality 55 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 56 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 57 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 58 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 59 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 60 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 61 | $127 | $190 — $317 |
| US — Carrier 01112 Locality 62 | $129 | $194 — $323 |
| US — Carrier 01112 Locality 63 | $130 | $196 — $326 |
| US — Carrier 01112 Locality 64 | $130 | $195 — $325 |
| US — Carrier 01112 Locality 65 | $144 | $217 — $361 |
| US — Carrier 01112 Locality 66 | $130 | $196 — $326 |
| US — Carrier 01112 Locality 67 | $132 | $197 — $329 |
| US — Carrier 01112 Locality 68 | $127 | $190 — $317 |
Frequently Asked Questions
How much does Office visit - established patient, high complexity cost?
The Medicare facility rate is $139. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Office visit - established patient, high 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 $139.