Office Visit — New Patient (Moderate)
What should this cost?
Medicare Pays
$111
National benchmark
Typical Range
$200–$450
What hospitals charge
Markup
3×
Above Medicare rate
What this code means on your bill
A new patient visit lasting 30-44 minutes involving moderate medical decision-making. The doctor takes a full history, performs an exam, and develops an initial treatment plan.
Commonly billed for
First visit for ongoing condition, initial evaluation requiring some testing
What to watch for
Upcoding
If your visit seemed straightforward but you see a high-level code, the provider may have billed for a more complex service than what was performed. Compare the code level to the time you actually spent with the doctor.
Duplicate charges
Check if this code appears more than once on the same date of service. Unless you had the same procedure performed twice (rare), a duplicate is likely a billing error.
Price check
If you're being charged more than 540 for this service, it's significantly above the typical range. Request an itemized bill and compare against the Medicare rate of $111.
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