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Established Patient Office Visit (level 1)

This is the smallest billable office visit for a patient the practice already knows — the brief, minimal encounter, often carried out by a nurse or medical assistant under the physician's supervision rather than by the physician face to face. A blood pressure recheck or a quick dressing look is the shape of it. It is the lowest-priced of the established patient visit levels.

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What it is

Office visits for established patients are billed on a five-step ladder, and this is the bottom rung — the one that exists for encounters too small to fit anywhere else. What distinguishes it is that it does not assume the physician was in the room. A staff member carries out a short, defined task that the physician has ordered, under that physician's supervision, and the practice records it as a visit. "Established" means the practice has seen you before; a first visit to a practice sits on a different ladder entirely. Because the work involved is minimal, this level carries the lowest payment of the five and is the one patients are most often surprised to see billed at all.

Why it is done

  • To recheck a blood pressure or a weight between physician appointments
  • To look at a wound, a dressing, or a healing site briefly
  • To review a simple result or confirm a patient is tolerating a medication
  • To carry out a short task the physician ordered at a previous visit

What to expect

These visits are short and usually take place with a nurse or medical assistant rather than the physician, though a physician has to be available in the office. There is a check-in at the front desk, the specific task, and a note in the chart. Because it looks and feels like "just a quick stop," it often comes as a surprise that a bill follows. It does: a charge is generated whenever the encounter is documented as a service, and if the practice is hospital-owned, a facility charge may follow it separately.

Questions worth asking

  • Will this quick visit be billed as an office visit, or is it included in the visit where the recheck was ordered?
  • If a nurse rather than the physician sees me, whose name does the claim go out under, and does my plan cover it the same way?
  • Does my plan apply a copay to this level of visit? A full office-visit copay can exceed what the practice is actually paid for it.
  • Is a blood pressure or injection administration charge billed on top of the visit itself?

What Established Patient Office Visit (level 1) costs by state

Established Patient Office Visit (level 1) prices at hospitals

See every published price for Established Patient Office Visit (level 1): the full national range, the state and hospital breakdowns, and which hospitals charge the least.

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Sources

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