What Is the Typical Medicare Reimbursement for a Visit to the Physician?


Quick Answer

As of 2015, the typical Medicare reimbursement to physicians for an office visit is 80 percent of the price if they are a participating provider, notes The Henry J. Kaiser Family Foundation. The majority of providers participate in Medicare. Those that are nonparticipating providers receive 80 percent of the cost after the price is reduced by five percent.

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Full Answer

Physicians who agree to become participating providers under Medicare agree to charge prices based on Medicare's current fee-schedule amount. In return, Medicare covers 80 percent of the price, while the patient pays the remaining 20 percent. For example, for a $100 visit, the patient is responsible for paying $20.

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