99204
E/M NewCMS status: AOffice or other outpatient visit, new patient, moderate-level MDM or 45-59 minutes total time.
Work RVU
2.60
Practice RVU
2.47
Malpractice RVU
0.24
Total RVU
5.31
2026 Medicare payment
$177.36
National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility
Model this code
Drop 99204 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
New patient with a moderately complex problem requiring comprehensive history, exam, and drug management. The default new-patient code in primary care and most subspecialties.
Documentation checklist
- ✓MDM moderate, OR 45-59 minutes total time on date of encounter.
- ✓Comprehensive history and exam are not required under 2021 guidelines but support the complexity narrative.
- ✓Patient must be truly new (no service from you or a same-specialty colleague in the practice in 3 years).
Common pitfalls
- !Coding a returning patient as new because they haven't been seen recently — the 3-year rule is firm.
- !Forgetting G2211 — new patient visits in continuity practices are eligible.
Common modifiers
2595
Common ICD-10 pairings
E11.9I10Z00.00
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.