CPT 99205 is the highest new-patient office visit level: about an hour, high complexity, typically a serious or complicated diagnosis, multiple chronic conditions, or decisions about major treatment. It is common in oncology, cardiology and neurology first visits.
What the price covers
When a hospital lists it, this is the price at a hospital-owned clinic or outpatient department, often with a facility fee on top of the clinician's fee. Any tests, imaging or procedures ordered are separate.
Why prices vary
Prices for the same visit level differ mainly by ownership: hospital-owned practices add facility fees; independent practices do not. Academic medical centers list the highest charges. Cash prices are usually far below the gross charge.
Questions to ask
- What is the self-pay price for 99205 including any facility fee?
- Could the visit be booked at an independent practice with the same specialist?
- What is included, and what will be billed separately?