Code Reality Check
99205 reimbursement rate: Office visit, new patient, 60-74 min
Office visit, new patient, 60-74 min (CPT 99205) pays a median $474.78 in Wisconsin and $175.03 in Oklahoma, against a Medicare anchor of $219.96. 51 of 51 states clear the publication floor.
spread 2.7x top to bottom
Medicare anchor $219.96
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $474.78 | 2.16x | $244–$631 · P90 $835 | 67,632 | Benchmark |
| North Dakota | $458.15 | 2.08x | $182–$549 · P90 $573 | 5,844 | Benchmark |
| South Dakota | $423.32 | 1.92x | $182–$548 · P90 $573 | 5,728 | Benchmark |
| Nebraska | $396.70 | 1.80x | $278–$468 · P90 $481 | 11,384 | Benchmark |
| Connecticut | $340.30 | 1.55x | $192–$551 · P90 $728 | 20,807 | Benchmark |
| New Hampshire | $336.57 | 1.53x | $221–$385 · P90 $561 | 14,707 | Benchmark |
| Massachusetts | $333.86 | 1.52x | $204–$493 · P90 $736 | 72,264 | Benchmark |
| Oregon | $299.66 | 1.36x | $183–$469 · P90 $555 | 24,804 | Benchmark |
| District of Columbia | $280.17 | 1.27x | $210–$392 · P90 $502 | 5,860 | Benchmark |
| Washington | $276.74 | 1.26x | $56–$401 · P90 $543 | 28,342 | Benchmark |
| Minnesota | $267.13 | 1.21x | $203–$632 · P90 $893 | 34,171 | Benchmark |
| Maryland | $266.67 | 1.21x | $202–$433 · P90 $502 | 34,915 | Benchmark |
| Colorado | $264.28 | 1.20x | $182–$491 · P90 $603 | 32,843 | Benchmark |
| North Carolina | $262.17 | 1.19x | $151–$360 · P90 $444 | 181,181 | Benchmark |
| Rhode Island | $260.18 | 1.18x | $180–$288 · P90 $404 | 9,929 | Benchmark |
| Idaho | $257.60 | 1.17x | $51–$296 · P90 $337 | 8,106 | Benchmark |
| West Virginia | $256.53 | 1.17x | $176–$458 · P90 $460 | 11,661 | Benchmark |
| South Carolina | $251.94 | 1.15x | $183–$395 · P90 $432 | 34,016 | Benchmark |
| Wyoming | $250.44 | 1.14x | $173–$304 · P90 $473 | 1,045 | Benchmark |
| Maine | $250.29 | 1.14x | $204–$343 · P90 $419 | 14,013 | Benchmark |
| Pennsylvania | $247.79 | 1.13x | $174–$384 · P90 $461 | 84,760 | Benchmark |
| Illinois | $245.78 | 1.12x | $188–$344 · P90 $471 | 57,731 | Benchmark |
| Virginia | $245.63 | 1.12x | $204–$294 · P90 $378 | 50,164 | Benchmark |
| New Mexico | $244.86 | 1.11x | $133–$268 · P90 $382 | 6,801 | Benchmark |
| Tennessee | $238.14 | 1.08x | $178–$411 · P90 $489 | 35,162 | Benchmark |
| Utah | $235.45 | 1.07x | $162–$336 · P90 $446 | 16,151 | Benchmark |
| California | $231.47 | 1.05x | $182–$498 · P90 $799 | 281,739 | Benchmark |
| Montana | $231.44 | 1.05x | $167–$350 · P90 $549 | 1,015 | Benchmark |
| Michigan | $230.87 | 1.05x | $191–$308 · P90 $368 | 47,745 | Benchmark |
| Iowa | $230.46 | 1.05x | $194–$372 · P90 $549 | 9,922 | Benchmark |
| Vermont | $230.03 | 1.05x | $48–$337 · P90 $409 | 2,150 | Benchmark |
| Arkansas | $228.22 | 1.04x | $75–$244 · P90 $326 | 10,090 | Benchmark |
| New Jersey | $227.48 | 1.03x | $160–$353 · P90 $480 | 39,948 | Benchmark |
| Georgia | $221.36 | 1.01x | $177–$354 · P90 $453 | 133,655 | Benchmark |
| Hawaii | $220.78 | 1.00x | $164–$294 · P90 $466 | 1,342 | Benchmark |
| Texas | $219.66 | 1.00x | $152–$268 · P90 $397 | 93,244 | Benchmark |
| Kansas | $215.36 | 0.98x | $185–$234 · P90 $296 | 7,971 | Benchmark |
| Delaware | $215.11 | 0.98x | $30–$249 · P90 $415 | 3,694 | Benchmark |
| Indiana | $214.30 | 0.97x | $175–$266 · P90 $311 | 73,682 | Benchmark |
| Alaska | $212.64 | 0.97x | $154–$308 · P90 $488 | 683 | Benchmark |
| Arizona | $211.44 | 0.96x | $169–$371 · P90 $600 | 16,830 | Benchmark |
| Missouri | $209.93 | 0.95x | $172–$286 · P90 $382 | 76,122 | Benchmark |
| Mississippi | $205.64 | 0.93x | $200–$242 · P90 $300 | 6,612 | Benchmark |
| Louisiana | $205.64 | 0.93x | $48–$247 · P90 $333 | 15,082 | Benchmark |
| Ohio | $203.84 | 0.93x | $149–$316 · P90 $465 | 131,468 | Benchmark |
| Nevada | $203.58 | 0.93x | $38–$246 · P90 $409 | 8,898 | Benchmark |
| New York | $203.06 | 0.92x | $127–$410 · P90 $576 | 279,984 | Benchmark |
| Florida | $181.01 | 0.82x | $58–$270 · P90 $412 | 87,313 | Benchmark |
| Alabama | $179.18 | 0.81x | $179–$234 · P90 $301 | 10,476 | Benchmark |
| Kentucky | $175.70 | 0.80x | $142–$258 · P90 $339 | 33,000 | Benchmark |
| Oklahoma | $175.03 | 0.80x | $40–$251 · P90 $309 | 9,715 | Benchmark |
Payer-blind local peer percentiles per state, full verified distribution. Publication floor: 11 verified rate points and a non-degenerate spread; the P25–P75 band unlocks at 25 points, P90 at 100 (a smaller cell's P90 is one contract, not a statistic).
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
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Cite this page
Source: Reddenda Code Reality Check, CPT 99205. Reddenda. https://reddenda.health/code/99205/
Derivation federally mandated TiC MRFs, verified to provider identity2,252,401 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0