CPT 99205 Fee Schedule

Last Verified: February 2026

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand High Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)

Key Fact	Detail
Service Type	• Evaluation and Management • Office or Other Outpatient Services
Common Place of Service	• 11 - Office • 22 - On Campus Outpatient Hospital • 20 - Urgent Care Facility
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 99205

National average reimbursement for CPT 99205 by major payers:

$232.57

$233.73

$227.41

$316.07

Preview provider-level rates for...

For billing codeCPT 99205

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99205
United	99205	$436.29	1912913880 - MARK SEWELL	540620889 - INOVA HEALTH CARE SERVICES	VA	Maternal & Fetal Medicine Physician (207VM0101X)
United	99205	$464.91	1720225626 - ROSLYNN MASON	540620889 - INOVA HEALTH CARE SERVICES	VA	Surgical Physician Assistant (363AS0400X)
United	99205	$333.44	1801125406 - MONICA BERLETTI	943302014 - ALAMEDA COUNTY MED CTR / ALAMEDA COUNTY MEDICAL GROUP / ALAMEDA HEALTH PARTNERS INC	CA	Obstetrics & Gynecology Physician (207V00000X)
United	99205	$157.13	1235697244 - MATERNAL & FETAL MEDICINE CENTER OF SOUTHERN CALIF. INC	833365827 - (CA) MATERNAL FETAL MEDICINE CENTER OF SOUTHERN CALIF INC	CA	Maternal & Fetal Medicine Physician (207VM0101X)
United	99205	$359.35	1942267802 - MICHAEL KWAN	262400924	TX	Cardiovascular Disease Physician (207RC0000X)
United	99205	$279.17	1447416748 - MICHAEL HAUK	593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC	FL	Medical Physician Assistant (363AM0700X)
United	99205	$262.76	1710277462 - MELISSA DRAKE	951683892 - COMMUNITY MEMORIAL HEALTH SYSTEM	CA	Obstetrics & Gynecology Physician (207V00000X)
United	99205	$474.20	1639768799 - ANDREA CHOO	540620889 - INOVA HEALTH CARE SERVICES	VA	Physical Therapist (225100000X)
United	99205	$458.50	1629039276 - CALVIN GREENE	593443182 - WOMENS CARE FLORIDA, LLP	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99205	$307.60	1821073305 - MARY CISHEK	264562522 - SETON FAMILY OF DOCTORS	TX	Cardiovascular Disease Physician (207RC0000X)
United	99205	$137.53	1629423355 - ANAT CHEMERINSKI	820584930 - (NJ) UNIVERSITY REPRODUCTIVE ASSOCIATES PC	NJ	Reproductive Endocrinology Physician (207VE0102X)
United	99205	$504.57	1942469630 - CAMILLE DIETERLE	954540991 - USC CARE MEDICAL GROUP INC	CA	Occupational Therapist (225X00000X)
United	99205	$150.14	1336144104 - JONATHAN DAVID, MD, PC	133968004 - (NY) JONATHAN DAVID MD PC	NY	Gastroenterology Physician (207RG0100X)
United	99205	$487.91	1679816862 - MARGARET PFEIFFER	954540991 - USC CARE MEDICAL GROUP INC	TX	Ophthalmic Plastic and Reconstructive Surgery Physician (207WX0200X)
United	99205	$100.00	1043296502 - LIANXI LIAO	751362682 - (TX) FORT WORTH HEART, P.A.	TX	Cardiovascular Disease Physician (207RC0000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 99205 vs. Other Office or Other Outpatient Services Codes

The CPT 99205 code is part of the Evaluation and Management services used for Office or Other Outpatient Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99205 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99202-CPT	Low	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99203-CPT	Low	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99204-CPT	Moderate	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99205-CPT	High	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand High Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99205 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99205) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo