Medicare rate for CPT 99205 in 2026

What CPT 99205 means

A first office or outpatient visit at the highest level: high-complexity medical decision making, or the most total time of any new-patient level.

How the $236.81 is built

Work RVU 3.50, practice-expense RVU 3.23 in an office and 0.94 in a facility, malpractice RVU 0.36. Each is multiplied by its geographic index, added together, then multiplied by the 2026 conversion factor of $33.4009. With every index at 1.000 that gives $236.81 in an office and $160.32 in a facility.

This is the allowed amount for one unit, before the 2% sequestration reduction and before any multiple-procedure reduction. It is what Medicare allows, not what a commercial carrier or an auto policy allows, and not what the provider billed. Current Procedural Terminology (CPT) is copyright 2019–2025 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

What CPT 99205 pays in New Jersey

New Jersey has 2 Medicare localities, so there is no single New Jersey rate. In an office the allowed amount runs from $252.58 to $262.26, a spread of 3.8% across the state.

CPT 99205 by fee-schedule year, 2023 to 2026

A bill is priced under the schedule in force on its date of service, not the one in force when it is reviewed. Note that 2024 has two entries: Congress changed the conversion factor on 9 March 2024, so a January 2024 date of service and a June 2024 date of service price differently.

National amounts, every geographic index at 1.000, so the year-to-year movement here is the fee schedule changing and not a change of location.

CPT 99205 in every state

The office allowed amount in each state, highest locality to lowest. Where a state shows one figure it has a single Medicare locality.

Checking a different code, state or year

The Medicare rate lookup prices all 17,000-plus codes in the Physician Fee Schedule for any state and any fee-schedule year from 2023 to 2026. Ambulance codes are priced separately on the ambulance fee schedule, because Medicare does not pay for ambulance transport under this schedule at all.

Other office visits codes

• CPT 99213 Established patient office visit, low complexity
• CPT 99214 Established patient office visit, moderate complexity
• CPT 99204 New patient office visit, moderate complexity
• CPT 99203 New patient office visit, low complexity

Other codes with a rate page

• CPT 99284 Emergency department visit, moderate complexity
• CPT 72148 MRI, lumbar spine, without contrast
• CPT 72141 MRI, cervical spine, without contrast
• CPT 70450 CT, head or brain, without contrast
• CPT 64483 Epidural steroid injection, lumbar, first level
• CPT 97110 Therapeutic exercise, each 15 minutes

Medicare rates are a benchmark, not an allowance. What a no-fault, workers’ compensation or commercial carrier owes for CPT 99205 is set by the fee schedule or policy that governs the claim, which is frequently a multiple of the figure above.