CPT code 99205: Office visit, new patient, high complexity2026 Medicare rate & RVUs in Auburn, Washington
CPT 99205: $241.18–$264.95 office ($160.63–$171.10 facility) across 2 localities in Auburn, WA in 2026 Medicare. Compare each area.
Medicare pays $241.18–$264.95 for 99205 in the office in Auburn, Washington, from Rest of Washington to King County, WA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 99205 pays more and less in Auburn, Washington
Auburn, Washington maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | $264.95 | $171.10 |
| Rest of Washington | $241.18 | $160.63 |
How payment areas work in Auburn
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Seattle (King Cnty) · King County
- Rest Of State · Pierce County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
How the 99205 rate is calculated
Each of 99205’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99205
RVUs × geographic indexes × conversion factor
Work3.50
3.50 RVUs× 1.000 GPCI
Practice expense3.23
3.23 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
7.0900
Conversion factor
$33.4009
Medicare rate
$236.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99205
99205 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.
Place of service · 99205
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$236.81
- Non-facility (office)
- $236.81
- Facility
- $160.32
Higher because the practice carries its own overhead.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 99205 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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