Established Patient Office Visit (level 4)

This level covers an established patient visit of moderate complexity — a chronic condition that has flared, several long-term conditions managed together, or a new problem serious enough to need real weighing up. It usually involves prescription decisions and outside records or results, and it is the second-highest of the five levels.

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What it is

Some appointments are not a single question with a single answer. This level describes the visit where several threads have to be held at once: two or more ongoing conditions to balance, or one that has worsened, or a new complaint with an uncertain diagnosis that could go more than one way. Moderate complexity in this system means there is a real amount to consider, outside information to pull in — prior notes, imaging, another clinician's opinion — and meaningful risk in the choices being made, such as starting or changing a prescription medication. As with the other levels, the clinician may support it either by that complexity or by the total time spent on your care that day.

Why it is done

To manage two or more chronic illnesses in one appointment, or one that has got worse since the last visit
To work up a new problem where the diagnosis is not yet settled
To start, stop, or substantially change a prescription medication
To bring together results, imaging, or another specialist's report and decide what they mean together

What to expect

These visits run longer and cover more ground. The clinician is likely to pull up previous records, look at test results with you, and explain a choice between options rather than simply state a plan. Referrals or further testing often come out of it. Because the level rests on documented reasoning rather than on the clock, two visits of equal length can be billed differently, and the same visit can be reviewed by a payer who disagrees with the level chosen.

Questions worth asking

If a small procedure — a joint injection, a skin lesion removed, a biopsy — was done at the same visit, it is billed separately from the visit itself. Will both appear, and does my plan pay both?
If my plan uses coinsurance rather than a flat copay, what is the practice's actual charge at this level, not just the allowed amount?
Were records or results reviewed from another provider, and could that work be billed as anything beyond this visit?
If I disagree with the level billed, how do I request an itemized statement and the supporting note?

What Established Patient Office Visit (level 4) costs by state

Established Patient Office Visit (level 4) cost in Texas — 90 hospitals, median $321.00
Established Patient Office Visit (level 4) cost in Florida — 74 hospitals, median $650.55
Established Patient Office Visit (level 4) cost in Illinois — 48 hospitals, median $281.40
Established Patient Office Visit (level 4) cost in California — 46 hospitals, median $161.16
Established Patient Office Visit (level 4) cost in Ohio — 37 hospitals, median $147.75
Established Patient Office Visit (level 4) cost in Tennessee — 37 hospitals, median $41.70
Established Patient Office Visit (level 4) cost in Wisconsin — 32 hospitals, median $267.50
Established Patient Office Visit (level 4) cost in Iowa — 29 hospitals, median $192.00
Established Patient Office Visit (level 4) cost in Pennsylvania — 29 hospitals, median $250.80
Established Patient Office Visit (level 4) cost in Michigan — 26 hospitals, median $180.48
Established Patient Office Visit (level 4) cost in Washington — 26 hospitals, median $177.20
Established Patient Office Visit (level 4) cost in Georgia — 25 hospitals, median $168.09
Established Patient Office Visit (level 4) cost in New Jersey — 23 hospitals, median $117.19
Established Patient Office Visit (level 4) cost in New York — 22 hospitals, median $369.35
Established Patient Office Visit (level 4) cost in Virginia — 22 hospitals, median $281.40
Established Patient Office Visit (level 4) cost in Arizona — 19 hospitals, median $1,644.83
Established Patient Office Visit (level 4) cost in Indiana — 19 hospitals, median $384.60
Established Patient Office Visit (level 4) cost in Missouri — 19 hospitals, median $168.85
Established Patient Office Visit (level 4) cost in Oklahoma — 18 hospitals, median $213.21
Established Patient Office Visit (level 4) cost in Minnesota — 17 hospitals, median $205.25
Established Patient Office Visit (level 4) cost in West Virginia — 16 hospitals, median $105.50
Established Patient Office Visit (level 4) cost in Kentucky — 15 hospitals, median $296.40
Established Patient Office Visit (level 4) cost in North Carolina — 14 hospitals, median $361.00
Established Patient Office Visit (level 4) cost in Nebraska — 13 hospitals, median $203.00
Established Patient Office Visit (level 4) cost in Oregon — 13 hospitals, median $278.25
Established Patient Office Visit (level 4) cost in Arkansas — 10 hospitals, median $187.85
Established Patient Office Visit (level 4) cost in Colorado — 10 hospitals, median $529.82
Established Patient Office Visit (level 4) cost in Mississippi — 10 hospitals, median $239.20
Established Patient Office Visit (level 4) cost in South Carolina — 10 hospitals, median $195.00
Established Patient Office Visit (level 4) cost in Kansas — 9 hospitals, median $263.20
Established Patient Office Visit (level 4) cost in Maine — 7 hospitals, median $360.30
Established Patient Office Visit (level 4) cost in South Dakota — 5 hospitals, median $252.00
Established Patient Office Visit (level 4) cost in Wyoming — 4 hospitals, median $909.07
Established Patient Office Visit (level 4) cost in Alaska — 3 hospitals, median $334.62
Established Patient Office Visit (level 4) cost in Nevada — 3 hospitals, median $948.18
Established Patient Office Visit (level 4) cost in Hawaii — 2 hospitals, median $61.76
Established Patient Office Visit (level 4) cost in Louisiana — 2 hospitals, median $190.06
Established Patient Office Visit (level 4) cost in Montana — 2 hospitals, median $192.00
Established Patient Office Visit (level 4) cost in North Dakota — 2 hospitals, median $233.60
Established Patient Office Visit (level 4) cost in Maryland — 1 hospitals, median $146.40
Established Patient Office Visit (level 4) cost in New Hampshire — 1 hospitals, median $341.20

Established Patient Office Visit (level 4) prices at hospitals

See every published price for Established Patient Office Visit (level 4): the full national range, the state and hospital breakdowns, and which hospitals charge the least.

Established Patient Office Visit (level 4) cost — see all prices →

Sources

CMS (Centers for Medicare & Medicaid Services): Evaluation & Management Services (opens in a new tab, leaves healthcosts.net)

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