Established Patient Office Visit (level 3)

This is the ordinary follow-up appointment — the middle rung of the five established patient visit levels, and the one billed more often than any other. A stable long-term condition reviewed, or a couple of minor problems handled together, with low-complexity decisions to make. It is the visit most people picture when they think of seeing their doctor.

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What it is

If you see a primary care physician twice a year to keep an eye on a condition that is behaving itself, this is almost certainly the code on the bill. It describes a visit of low decision-making complexity: one stable chronic illness being reviewed, or two or more minor problems dealt with in the same sitting, with modest data to consider and limited risk in what is decided. The level is set either by that complexity or by the total time the clinician spent on your care that day, including the work before and after the room — reviewing records, ordering tests, documenting. Whichever of the two supports the level, the clinician may use.

Why it is done

To review a chronic condition such as high blood pressure, thyroid disease, or asthma that is currently stable
To handle two or more small complaints in one appointment
To assess an acute illness that needs judgment but carries little risk
To adjust an ongoing treatment modestly and arrange the next check

What to expect

The rhythm is familiar: vitals taken by staff, a discussion of how things have gone since last time, a focused examination, results reviewed, and prescriptions renewed or adjusted. Tests may be ordered for afterward. The clinician's documentation of the problems addressed and the reasoning applied is what determines the level billed, so a visit that felt routine to you may be recorded as more or less involved than you expected.

Questions worth asking

If part of the appointment was an annual wellness or preventive visit and part of it dealt with a problem, will two codes be billed, and will the problem-focused half carry cost sharing that the preventive half does not?
Were tests ordered during the visit billed by this office or by an outside laboratory, and is that lab in my network?
Does my plan count this visit toward the deductible, or does a copay apply from the first visit of the year?
If this practice bills a facility charge in addition to the physician charge, can I see both amounts before I schedule?

What Established Patient Office Visit (level 3) costs by state

Established Patient Office Visit (level 3) cost in Texas — 86 hospitals, median $214.20
Established Patient Office Visit (level 3) cost in Florida — 75 hospitals, median $548.68
Established Patient Office Visit (level 3) cost in Illinois — 48 hospitals, median $190.80
Established Patient Office Visit (level 3) cost in California — 43 hospitals, median $106.70
Established Patient Office Visit (level 3) cost in Ohio — 37 hospitals, median $126.00
Established Patient Office Visit (level 3) cost in Tennessee — 37 hospitals, median $36.30
Established Patient Office Visit (level 3) cost in Wisconsin — 32 hospitals, median $210.33
Established Patient Office Visit (level 3) cost in Iowa — 30 hospitals, median $160.80
Established Patient Office Visit (level 3) cost in Pennsylvania — 29 hospitals, median $216.00
Established Patient Office Visit (level 3) cost in Virginia — 28 hospitals, median $172.20
Established Patient Office Visit (level 3) cost in Michigan — 26 hospitals, median $114.33
Established Patient Office Visit (level 3) cost in Washington — 25 hospitals, median $177.20
Established Patient Office Visit (level 3) cost in New Jersey — 22 hospitals, median $106.60
Established Patient Office Visit (level 3) cost in New York — 22 hospitals, median $297.19
Established Patient Office Visit (level 3) cost in Arizona — 19 hospitals, median $1,066.42
Established Patient Office Visit (level 3) cost in Indiana — 19 hospitals, median $318.00
Established Patient Office Visit (level 3) cost in Missouri — 19 hospitals, median $130.65
Established Patient Office Visit (level 3) cost in Oklahoma — 18 hospitals, median $165.39
Established Patient Office Visit (level 3) cost in Minnesota — 17 hospitals, median $171.94
Established Patient Office Visit (level 3) cost in West Virginia — 16 hospitals, median $72.00
Established Patient Office Visit (level 3) cost in Georgia — 14 hospitals, median $399.00
Established Patient Office Visit (level 3) cost in Kentucky — 14 hospitals, median $233.40
Established Patient Office Visit (level 3) cost in North Carolina — 14 hospitals, median $340.20
Established Patient Office Visit (level 3) cost in Nebraska — 13 hospitals, median $191.50
Established Patient Office Visit (level 3) cost in Oregon — 13 hospitals, median $189.00
Established Patient Office Visit (level 3) cost in South Carolina — 11 hospitals, median $188.50
Established Patient Office Visit (level 3) cost in Colorado — 10 hospitals, median $470.82
Established Patient Office Visit (level 3) cost in Kansas — 10 hospitals, median $562.57
Established Patient Office Visit (level 3) cost in Mississippi — 10 hospitals, median $204.20
Established Patient Office Visit (level 3) cost in Arkansas — 9 hospitals, median $167.05
Established Patient Office Visit (level 3) cost in Maine — 7 hospitals, median $335.60
Established Patient Office Visit (level 3) cost in Alaska — 5 hospitals, median $219.96
Established Patient Office Visit (level 3) cost in South Dakota — 5 hospitals, median $199.20
Established Patient Office Visit (level 3) cost in Wyoming — 4 hospitals, median $591.53
Established Patient Office Visit (level 3) cost in Nevada — 3 hospitals, median $95.12
Established Patient Office Visit (level 3) cost in Hawaii — 2 hospitals, median $41.92
Established Patient Office Visit (level 3) cost in Louisiana — 2 hospitals, median $410.54
Established Patient Office Visit (level 3) cost in Montana — 2 hospitals, median $150.40
Established Patient Office Visit (level 3) cost in North Dakota — 2 hospitals, median $184.80
Established Patient Office Visit (level 3) cost in Maryland — 1 hospitals, median $117.00
Established Patient Office Visit (level 3) cost in New Hampshire — 1 hospitals, median $339.80

Established Patient Office Visit (level 3) prices at hospitals

See every published price for Established Patient Office Visit (level 3): the full national range, the state and hospital breakdowns, and which hospitals charge the least.

Established Patient Office Visit (level 3) cost — see all prices →

Sources

CMS (Centers for Medicare & Medicaid Services): Evaluation & Management Services (opens in a new tab, leaves healthcosts.net)
Medicare.gov: Doctor & other health care provider services (opens in a new tab, leaves healthcosts.net)

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