Price Checker / CPT 99205
How much does New patient office visit — complex cost?
CPT 99205 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is in line with what this normally costs. No need to dispute.
Fair price
$480–$570
What this should cost
With insurance
~$435,400
Typical out-of-pocket
Overcharged if over
$710
Push back above this
What hospitals charge for New patient office visit — complex
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| UPMC Western Psychiatric , PA | $750 | $600 | 217% |
| UM R Adams Cowley Shock Trauma Center Baltimore, MD | $540 | — | 128% |
| Northeast Texas Rural Health Clinic Mt. Pleasant, TX | $606 | — | 105% |
| Pathways Behavioral Health Services , TN | $474 | $474 | 100% |
| Pennsylvania Psychiatric Institute Harrisburg, PA | $568 | — | 92% |
| Mackinac Straits Health System Saint Ignace, MI | $491 | — | 90% |
| hebrew rehabilitation center hospital Boston, MA | $441 | — | 88% |
| EHHS Milton Clinic Medicare , WI | $420 | $307 | 77% |
| Lindner Center of Hope MASON, OH | $420 | — | 74% |
| Pine Rest Christian Mental Health Services GRAND RAPIDS, MI | $411 | $329 | 74% |
| Aspire Health Partners, Inc Orlando, FL | $210 | — | 45% |
| Barnes-Kasson County Hospital SUSQUEHANNA, PA | $314 | $220 | 33% |
| JD McCarty Center Norman, OK | $225 | — | 33% |
| Highland Springs LLC BEACHWOOD, OH | $300 | $950 | 27% |
| Foard County Clinic Crowell, TX | $320 | — | 22% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About New patient office visit — complex
CPT code 99205 refers to new patient office visit — complex (billing description: "Office o/p new hi 60 min"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $160 in a facility (hospital or surgery center) and $237 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.