Price Checker / CPT 99205
CPT 99205 — Office o/p new hi 60 min
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$160
What Medicare pays in a hospital/ASC setting
$237
What Medicare pays in a physician's office
$433
Based on 21 hospital(s) in our database
What do these numbers mean?
The Medicare rateis what the federal government determines is a fair payment for this procedure. It's based on the Relative Value Unit (RVU) system, which accounts for physician work, practice expense, and malpractice cost. Hospitals and providers often charge 3-20x this amount. If your bill is significantly higher than the Medicare rate, you may have grounds to negotiate.
Hospital Charges for CPT 99205
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| UCSF Health Saint Francis Hospital San Francisco, CA | $926 | — | 422279364% |
| Arroyo Grande Community Hospital Arroyo Grande, CA | $567 | — | 422179% |
| 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 , OH | $420 | $248 | 77% |
| Lindner Center of Hope , OH | $420 | — | 74% |
| Pine Rest Christian Mental Health Services , MI | $411 | $329 | 74% |
| Aspire Health Partners, Inc Orlando, FL | $210 | — | 45% |
| Barnes-Kasson County Hospital , PA | $314 | $220 | 33% |
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About CPT 99205
CPT code 99205 refers to “Office o/p new hi 60 min”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $160 in a facility (hospital or ambulatory surgery center) and $237in a non-facility (physician's office) setting.
These rates are set by CMS (Centers for Medicare & Medicaid Services) and represent what the government considers a fair payment for this service. While commercial insurance typically pays somewhat more than Medicare, many hospitals charge significantly higher amounts — sometimes 10-50x the Medicare rate.
What to do if you were overcharged
- Upload your bill— we'll identify this code and compare it against the rates shown above.
- Get a dispute letter— citing the Medicare rate and your hospital's own published pricing data.
- Negotiate or let us handle it — 25% of savings, no savings = no fee.