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99205 Medicare Reimbursement Rate (2026)

Current CMS pricing and breakdown for Office o/p new hi 60 min.

CPT Code 99205

National Average Payment

Non-Facility (Private Office) Rate

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$236.81
Effective Jan 1, 2026

⚠️ This is a National Estimate

Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).

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Code Description

Office o/p new hi 60 min

2026 Breakdown

ComponentOffice (Non-Fac)Facility (Hosp)
Work RVU3.53.5
Practice Expense (PE)3.230.94
Malpractice (MP)0.360.36
Total RVUs7.094.80

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Nearby Codes

9920499206