Is CPT 99205 overcharged?
99205: Office visit, new patient, high complexity (Office visit)
Approximate Medicare national rate
$236.81
Source: CMS Physician Fee Schedule CY2026, Oct release (national, non-facility). National amount; actual Medicare payment varies by locality. Facility-setting physician rate: $160.32 (hospital facility fee billed separately).
What's a reasonable charge?
Commercial insurers typically pay roughly 1.5 to 2.5 times Medicare. If you were billed more than $710.43 for 99205, ask for an itemized bill, request the provider's cash price, and dispute the difference.
Check your whole bill
Duplicates and unbundling are often worth more than a single high price. Scan your bill free