# CPT 99205: New patient office/outpatient visit, high medical decision making

Medicare CPT 99205 pays $236.81 in a non-facility setting and $160.32 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $215.77 in Arkansas to $296.88 in Alaska, a 38% spread.

Web page: https://www.med-reveal.com/rates/99205-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Allergy & Immunology, Cardiovascular Disease, Child & Adolescent Psychiatry, Clinic/Center, Clinical Genetics (M.D.), Dermatology, Endocrinology, Evaluation, Family Medicine, Gastroenterology, General Surgery, Hematology & Oncology, Infectious Disease, Internal Medicine, Methadone Clinic, Neurological Surgery, Neurology, Obstetrics & Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Pain Medicine, Pediatrics, Plastic Surgery, Psychiatry & Neurology, Pulmonary Disease, Rheumatology, Sleep Medicine, Sports Medicine, Thoracic Surgery (Cardiothoracic Vascular Surgery), Urology, Vascular Surgery

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $236.81 |
| National facility | $160.32 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $296.88 | $215.42 |
| District of Columbia | $263.69 | $173.58 |
| New York | $259.15 | $173.82 |
| New Jersey | $257.42 | $171.30 |
| California | $255.27 | $164.77 |
| Washington | $253.07 | $165.87 |
| Massachusetts | $251.58 | $165.65 |
| Connecticut | $249.98 | $167.61 |
| Florida | $248.55 | $171.81 |
| Hawaii | $246.53 | $159.56 |
| Illinois | $244.54 | $170.63 |
| Maryland | $243.85 | $164.11 |
| Colorado | $242.49 | $161.10 |
| Rhode Island | $241.30 | $162.28 |
| Oregon | $240.20 | $159.62 |
| New Hampshire | $239.73 | $160.11 |
| Puerto Rico | $237.82 | $160.49 |
| Virgin Islands | $237.82 | $160.49 |
| Montana | $236.79 | $160.30 |
| Pennsylvania | $236.48 | $161.57 |
| Michigan | $235.14 | $163.31 |
| Texas | $234.93 | $159.63 |
| Nevada | $234.91 | $158.35 |
| Delaware | $234.89 | $159.32 |
| Georgia | $234.39 | $161.42 |
| Wyoming | $233.69 | $157.20 |
| Arizona | $231.74 | $157.62 |
| Minnesota | $231.48 | $152.77 |
| Virginia | $231.44 | $156.26 |
| New Mexico | $230.27 | $160.14 |
| Vermont | $229.79 | $154.07 |
| North Dakota | $229.67 | $153.18 |
| Utah | $229.11 | $157.21 |
| South Dakota | $228.83 | $152.34 |
| Louisiana | $227.99 | $158.16 |
| West Virginia | $227.86 | $161.39 |
| Missouri | $227.74 | $157.55 |
| Maine | $227.52 | $154.44 |
| Ohio | $227.52 | $157.69 |
| South Carolina | $226.81 | $156.13 |
| North Carolina | $225.24 | $153.88 |
| Wisconsin | $223.96 | $150.68 |
| Kentucky | $223.82 | $155.82 |
| Indiana | $222.76 | $151.85 |
| Oklahoma | $222.59 | $154.28 |
| Idaho | $221.84 | $151.48 |
| Tennessee | $221.43 | $151.90 |
| Nebraska | $221.03 | $150.43 |
| Kansas | $220.49 | $151.35 |
| Iowa | $220.39 | $150.40 |
| Mississippi | $218.68 | $152.82 |
| Alabama | $218.11 | $151.18 |
| Arkansas | $215.77 | $150.07 |

## Related codes

- 99202: New patient office/outpatient visit, straightforward medical decision making — https://www.med-reveal.com/rates/99202-cpt-fee-schedule
- 99203: New patient office/outpatient visit, low medical decision making — https://www.med-reveal.com/rates/99203-cpt-fee-schedule
- 99204: New patient office/outpatient visit, moderate medical decision making — https://www.med-reveal.com/rates/99204-cpt-fee-schedule

Commercial negotiated rates for 99205 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules