CMS Transmittal R13945MPI: Updates to Chapter 3, Chapter 4, and Chapter 5 in Publication (Pub.) 100-15, Including Updates…
Medicaid
CPT procedure code
99204 — Office/outpatient visit, new patient, moderate-high complexity
E/MCPT
Medicare payment
$177.36
2026 Physician Fee Schedule · non-facility
Source: CMS Physician Fee Schedule (PPRRVU 2026). CMS fee schedules ↗ · PFS status indicator A
National amount before geographic adjustment. Your MAC's locality rate will differ.
Code definition
Code
99204
Code system
CPT (Current Procedural Terminology)
Description
Office/outpatient visit, new patient, moderate-high complexity
Category
E/M
Short description sourced from CMS publicly available fee schedule data. Full CPT descriptions are copyright AMA. Not a substitute for the official CPT codebook.
Latest reimbursement alerts
No policy changes are currently matched to 99204. Here are the latest changes across all codes.
High
FDA Approval: RASONQUE (DARAXONRASIB) — Type 1 - New Molecular Entity
Oncology
FDA Approval: VOBRIG (LEUPROLIDE ACETATE) — Type 5 - New Formulation or New Manufacturer
Oncology
FDA Approval: NDA 220106 — Type 1 - New Molecular Entity
Multi-specialty
FDA Approval: BIXLENVO (BICTEGRAVIR/LENACAPAVIR) — Type 4 - New Combination
Infectious Disease
FDA Approval: NDA 221443 — Type 4 - New Combination
Multi-specialty
Audit documentation
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Related CPT codes (992xx)
99202E/MOffice/outpatient visit, new patient, low complexity
99203E/MOffice/outpatient visit, new patient, moderate complexity
99205E/MOffice/outpatient visit, new patient, high complexity
99211E/MOffice/outpatient visit, established patient, minimal
99212E/MOffice/outpatient visit, established patient, straightforward
99213E/MOffice/outpatient visit, established patient, low complexity
99214E/MOffice/outpatient visit, established patient, moderate complexity
99215E/MOffice/outpatient visit, established patient, high complexity
99221E/MInitial hospital inpatient care, low complexity
99222E/MInitial hospital inpatient care, moderate complexity
99223E/MInitial hospital inpatient care, high complexity
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