99203

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more

Code 99203. Medicare covered 8,656,567 of these. Here is what providers billed and what Medicare allowed, state by state.

$265.96Billed, national avg
$103.44Medicare allowed
2.6xBilled vs allowed
2.9xHighest vs lowest state

Providers in Alaska billed the most for this, at $357.37. In Puerto Rico the average was $123.69. 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$357.37$122.542.9x24,069
Wisconsin$352.65$92.913.8x125,723
New York$346.06$116.753.0x652,085
Massachusetts$338.58$106.763.2x241,261
Minnesota$331.29$98.943.3x109,972
Nevada$300.98$102.312.9x74,354
New Jersey$298.60$115.822.6x340,862
California$297.18$113.332.6x774,089
Oregon$296.77$100.922.9x84,818
Armed Forces Europe$288.88$102.002.8x138
Georgia$282.32$100.982.8x262,573
New Hampshire$275.70$96.442.9x52,727
Florida$273.73$105.172.6x720,089
Connecticut$273.55$109.312.5x105,983
District of Columbia$268.35$114.322.3x21,029
Colorado$267.40$104.132.6x129,704
Rhode Island$265.63$103.882.6x28,287
Washington$263.17$103.902.5x156,131
Arizona$260.42$100.402.6x259,872
Wyoming$260.35$100.982.6x19,113
Nebraska$260.13$93.082.8x57,617
Maryland$259.30$110.142.4x237,620
Texas$257.16$101.632.5x556,930
Illinois$256.29$104.622.4x331,671
Foreign Country$251.83$88.392.8x166
North Carolina$249.52$96.842.6x261,564
Ohio$241.74$95.302.5x304,419
Delaware$241.70$102.512.4x48,626
Iowa$240.31$93.742.6x84,566
Armed Forces Pacific$239.42$96.862.5x303
Virginia$239.05$102.422.3x267,412
New Mexico$238.18$95.742.5x46,875
Pennsylvania$237.74$102.022.3x379,617
Tennessee$235.62$95.582.5x185,083
Missouri$233.13$96.252.4x150,720
Montana$232.37$96.822.4x34,932
Hawaii$231.03$105.622.2x24,868
Maine$230.92$91.572.5x24,435
Utah$230.67$98.822.3x59,707
Louisiana$230.37$96.002.4x94,839
Oklahoma$225.97$95.662.4x101,669
North Dakota$225.35$84.982.7x21,757
West Virginia$222.72$91.062.4x43,530
Virgin Islands$220.80$103.342.1x1,990
South Carolina$219.27$98.142.2x177,568
Kansas$218.53$94.142.3x86,574
Idaho$216.40$89.202.4x48,811
Kentucky$214.82$95.832.2x115,199
Indiana$210.97$97.152.2x173,684
Michigan$206.35$100.432.1x208,708
South Dakota$200.71$87.982.3x30,795
Arkansas$192.99$92.192.1x93,406
Mississippi$188.55$93.222.0x80,698
Alabama$188.51$94.842.0x101,965
Guam$179.33$107.401.7x1,521
Unknown$167.14$115.001.5x482
Vermont$166.32$85.232.0x17,658
Armed Forces Central/South America$157.62$103.231.5x36
Northern Mariana Islands$156.27$99.801.6x14
Puerto Rico$123.69$106.141.2x15,632

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

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