How Much Does Established Patient Office Visit - Moderate Complexity Cost?
Also known as: Office o/p est mod 30 min (CPT 99214)
A longer follow-up visit for a condition that needs more detailed evaluation or management.
Established Patient Office Visit - Moderate Complexity (CPT 99214) costs $85 at Medicare rates.
The rates shown below represent the complete Medicare reimbursement for this service. No separate facility fee applies for this type of procedure.
Patient Guide: Established Patient Office Visit - Moderate Complexity
What you need to know before your appointment
What to Expect
The doctor will spend extra time reviewing your condition, may order additional tests, and will discuss adjustments to your treatment plan.
How Long Does It Take?
25-35 minutes
Common Reasons Doctors Order This
Worsening condition, chronic disease management, multiple health issues, pre-procedure evaluation
How to Prepare
Prepare a detailed list of symptoms with timing. Bring recent test results and notes from other doctors.
Procedures Commonly Done Together
These procedures are frequently performed alongside Office o/p est mod 30 min
What Insurance Companies Actually Pay
Real negotiated rates from 9 hospitals across 5 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $212 | $31 - $386 | 6 |
| Cigna | $237 | $67 - $468 | 6 |
| United | $134 | $22 - $329 | 4 |
| BCBS-TX | $189 | $117 - $254 | 3 |
| Kaiser | $94 | $21 - $190 | 2 |
| Multiplan | $330 | $73 - $658 | 3 |
| CHC | $173 | $45 - $265 | 2 |
| Humana | $231 | $76 - $313 | 3 |
| BCBS | $234 | $187 - $258 | 1 |
| Peach State | $125 | $56 - $241 | 2 |
| BCBS - Anthem | $195 | $79 - $269 | 1 |
| OPTUM | $234 | $130 - $398 | 1 |
How to Reduce Your Cost for Office o/p est mod 30 min
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($136) differs from the facility rate ($85). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (4.06) x CF ($33.40) = $136
Related Procedures
Similar procedures in the same category or body system
Consider These Alternatives
Depending on your clinical situation, these alternatives may be appropriate and could save you money.
Note: Alternative procedures may not be clinically appropriate for all patients. Always consult your physician to determine the best option for your specific situation.
People Also Ask
Common questions people search for about this procedure
How much does it cost just to see a doctor?
How much is a doctor's visit without insurance in the US?
A primary care visit without insurance typically costs 0 to 00, with an average of 71 across major U.S. cities. Labs, imaging, and procedures are billed separately and can significantly increase costs—basic blood work runs 9 to 9 per test.
Is it cheaper to see a doctor without insurance?
Across the United States, patients without insurance often get hit with some of the steepest prices for a basic check-up. A study from Johns Hopkins found that the average "cash price" for a new uninsured patient was about 60.
What is a fee for each doctor visit?
The cost of a doctor's visit without insurance varies, but on average, it falls between 00 and 00. Emergency visits can be significantly higher.
Frequently Asked Questions
How much does Office o/p est mod 30 min cost?
The Medicare facility rate for Office o/p est mod 30 min is $85. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Office o/p est mod 30 min cost without insurance?
Without insurance, the cost of Office o/p est mod 30 min can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Office o/p est mod 30 min?
Most commercial health insurance plans and Medicare cover Office o/p est mod 30 min when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.