99202

New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more

Code 99202. Medicare covered 832,888 of these. Here is what providers billed and what Medicare allowed, state by state.

$171.47Billed, national avg
$66.24Medicare allowed
2.6xBilled vs allowed
2.9xHighest vs lowest state

Providers in Alaska billed the most for this, at $237.53. In Puerto Rico the average was $81.58. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$237.53$77.953.0x2,499
Wisconsin$231.28$58.264.0x16,337
New York$218.89$74.402.9x60,654
Minnesota$218.86$64.883.4x13,965
Massachusetts$216.06$69.413.1x22,195
California$203.21$73.862.8x72,388
Oregon$196.40$65.563.0x7,776
New Jersey$188.52$74.292.5x29,085
Wyoming$186.58$66.522.8x2,935
New Hampshire$185.44$60.573.1x4,415
Nevada$184.45$66.802.8x6,034
Washington$179.03$67.072.7x14,952
Rhode Island$177.99$67.462.6x2,951
Connecticut$177.32$70.392.5x12,458
Illinois$174.90$65.572.7x34,497
District of Columbia$173.99$75.212.3x2,209
Maryland$171.35$71.202.4x22,250
Florida$170.68$66.652.6x57,720
Colorado$170.56$67.102.5x11,481
Georgia$169.87$64.202.6x22,500
Nebraska$167.91$60.402.8x6,413
Arizona$167.47$64.362.6x20,127
Ohio$162.71$59.672.7x33,023
Hawaii$162.50$68.622.4x3,010
Texas$162.12$66.082.5x50,475
New Mexico$162.00$60.542.7x4,370
Iowa$159.49$60.292.6x9,632
North Carolina$158.38$62.712.5x25,290
Virginia$154.33$66.412.3x26,126
Missouri$150.81$60.922.5x15,865
Maine$150.23$58.612.6x2,565
Tennessee$148.90$61.372.4x16,712
South Carolina$148.88$63.892.3x15,315
Montana$148.88$62.582.4x4,457
Utah$147.83$64.252.3x5,574
North Dakota$146.91$55.672.6x2,206
West Virginia$146.29$58.832.5x6,272
Kansas$145.53$61.172.4x8,107
Pennsylvania$144.98$65.612.2x41,915
Louisiana$144.52$63.062.3x11,195
Delaware$144.34$66.722.2x5,191
Oklahoma$142.64$61.342.3x9,796
South Dakota$141.81$57.172.5x3,519
Indiana$140.25$62.102.3x17,377
Idaho$137.38$57.342.4x4,896
Michigan$133.47$64.742.1x21,741
Kentucky$131.13$60.832.2x10,033
Virgin Islands$130.90$68.151.9x260
Alabama$128.87$61.232.1x9,966
Arkansas$123.93$59.182.1x9,264
Mississippi$120.81$58.862.1x9,146
Guam$119.28$67.581.8x143
Vermont$107.90$54.582.0x2,073
Northern Mariana Islands$103.85$66.761.6x63
Puerto Rico$81.58$67.171.2x1,443

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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