What is New Patient Doctor Visit (60-74 min) (CPT 99205)?

In-depth initial evaluation with a new specialist for complex, multi-system medical concerns. This clinical code is utilized across practices and hospitals for diagnostic and therapeutic service documentation.

What do doctors typically charge for New Patient Doctor Visit (60-74 min)?

The nationwide median physician charge for New Patient Doctor Visit (60-74 min) (CPT 99205) is $490.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 99205?

The standard insurance baseline reimbursement rate is $207.63. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/New Patient Doctor Visit (60-74 min)

CPT 99205New Patient Visit

New Patient Doctor Visit (60-74 min)

In-depth initial evaluation with a new specialist for complex, multi-system medical concerns. Clinical pricing breakdown and utilization metrics across 66,257 practicing doctors nationwide.

$490.00

Peer Median Charge

Gross billed rate

$207.63

Standard Baseline

Customary allowable

2.4x

National Markup

Charge vs baseline

66,257

Active Physicians

Billing this code

Planning care or already received a bill for CPT 99205?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

Calculate Bundled Cost →Dispute an Inflated Bill 🧾

Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $490.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $207.63 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 99205 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"