# CPT 99204: New patient office/outpatient visit, moderate medical decision making

Medicare CPT 99204 pays $177.36 in a non-facility setting and $116.90 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $161.84 in Arkansas to $222.54 in Alaska, a 38% spread.

Web page: https://www.med-reveal.com/rates/99204-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Allergy & Immunology, Cardiovascular Disease, Child & Adolescent Psychiatry, Clinic/Center, Clinical Genetics (M.D.), Dermatology, Endocrinology, Evaluation, Family Medicine, Gastroenterology, General Surgery, Hematology & Oncology, Infectious Disease, Internal Medicine, Methadone Clinic, Neurological Surgery, Neurology, Obstetrics & Gynecology, Ophthalmology, Optometrist, Orthopaedic Surgery, Otolaryngology, Pain Medicine, Pediatrics, Plastic Surgery, Psychiatry & Neurology, Pulmonary Disease, Rheumatology, Sleep Medicine, Sports Medicine, Thoracic Surgery (Cardiothoracic Vascular Surgery), Urology, Vascular Surgery

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $177.36 |
| National facility | $116.90 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $222.54 | $158.16 |
| District of Columbia | $197.64 | $126.42 |
| New York | $193.89 | $126.45 |
| New Jersey | $192.89 | $124.82 |
| California | $191.92 | $120.39 |
| Washington | $189.95 | $121.03 |
| Massachusetts | $188.77 | $120.85 |
| Connecticut | $187.13 | $122.02 |
| Hawaii | $185.29 | $116.55 |
| Florida | $185.22 | $124.57 |
| Maryland | $182.62 | $119.59 |
| Illinois | $182.18 | $123.77 |
| Colorado | $181.93 | $117.60 |
| Rhode Island | $180.87 | $118.41 |
| Oregon | $180.25 | $116.56 |
| New Hampshire | $179.74 | $116.80 |
| Puerto Rico | $178.15 | $117.03 |
| Virgin Islands | $178.15 | $117.03 |
| Montana | $177.34 | $116.89 |
| Pennsylvania | $177.00 | $117.79 |
| Nevada | $176.10 | $115.59 |
| Delaware | $175.99 | $116.26 |
| Texas | $175.99 | $116.47 |
| Michigan | $175.60 | $118.82 |
| Georgia | $175.27 | $117.60 |
| Wyoming | $175.27 | $114.82 |
| Minnesota | $174.11 | $111.90 |
| Arizona | $173.65 | $115.07 |
| Virginia | $173.60 | $114.17 |
| North Dakota | $172.60 | $112.14 |
| Vermont | $172.57 | $112.72 |
| New Mexico | $172.12 | $116.68 |
| South Dakota | $172.04 | $111.58 |
| Utah | $171.59 | $114.76 |
| Maine | $170.70 | $112.93 |
| Louisiana | $170.56 | $115.36 |
| Missouri | $170.44 | $114.96 |
| Ohio | $170.25 | $115.05 |
| West Virginia | $170.01 | $117.47 |
| South Carolina | $169.89 | $114.03 |
| North Carolina | $168.94 | $112.53 |
| Wisconsin | $168.35 | $110.43 |
| Kentucky | $167.52 | $113.77 |
| Indiana | $167.22 | $111.17 |
| Oklahoma | $166.74 | $112.76 |
| Idaho | $166.53 | $110.92 |
| Tennessee | $166.14 | $111.19 |
| Nebraska | $166.02 | $110.22 |
| Iowa | $165.51 | $110.20 |
| Kansas | $165.46 | $110.81 |
| Mississippi | $163.80 | $111.75 |
| Alabama | $163.57 | $110.67 |
| Arkansas | $161.84 | $109.91 |

## Related codes

- 99202: New patient office/outpatient visit, straightforward medical decision making — https://www.med-reveal.com/rates/99202-cpt-fee-schedule
- 99203: New patient office/outpatient visit, low medical decision making — https://www.med-reveal.com/rates/99203-cpt-fee-schedule
- 99205: New patient office/outpatient visit, high medical decision making — https://www.med-reveal.com/rates/99205-cpt-fee-schedule

Commercial negotiated rates for 99204 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules