99204
Office o/p new mod 45 min
Office or other outpatient visit, new patient, moderate-level medical decision making OR 45-59 minutes of total time on the date of the encounter.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
Billing guidance for 99204 is locked
- When to use it: the exact clinical situations that support billing 99204
- Documentation checklist: the 6 elements your note needs before submitting
- Common pitfalls: the 5 mistakes that get 99204 downcoded or denied
Payer notes
Verify current payer coverage and documentation requirements. Medicare Advantage and commercial payment depend on the plan or contract; a utilization percentage alone does not determine the correct code.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what 99204 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.