CPT 99404

Prev Med Cnsl&/Rsk Fctr Rdctj Indv Approx 60 Min

CPT 99404 pays $113.23 in a non-facility setting and $83.17 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $105.07 in Arkansas to $146.86 in Alaska, a 40% spread.

National non-facility rate

$113.23

Office and other outpatient settings

Facility rate
$83.17

Hospital and ASC settings

Highest state
$146.86

Alaska

Lowest state
$105.07

Arkansas · 40% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $113.23
CPT 99404 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $113.23, national facility $83.17.
StateRate compared visuallyNon-facilityFacility
Alaska
$146.86$114.85
District of Columbia
$125.05$89.64
New York
$122.85$89.32
New Jersey
$122.47$88.62
California
$121.81$86.24
Washington
$120.61$86.34
Massachusetts
$119.90$86.13
Connecticut
$118.77$86.39
Hawaii
$117.58$83.40
Florida
$117.17$87.01
Maryland
$116.26$84.92
Colorado
$115.95$83.97
Illinois
$115.62$86.57
Rhode Island
$115.49$84.44
Oregon
$115.00$83.33
New Hampshire
$114.54$83.24
Puerto Rico
$113.65$83.26
Virgin Islands
$113.65$83.26
Montana
$113.22$83.16
Pennsylvania
$113.19$83.74
Delaware
$112.62$82.92
Texas
$112.62$83.02
Nevada
$112.60$82.51
Wyoming
$112.19$82.13
Michigan
$112.17$83.95
Georgia
$112.09$83.41
Minnesota
$111.69$80.75
Virginia
$111.30$81.75
Arizona
$111.29$82.16
North Dakota
$110.85$80.79
Vermont
$110.81$81.05
South Dakota
$110.57$80.51
New Mexico
$110.38$82.81
Utah
$110.17$81.92
Maine
$109.77$81.05
Louisiana
$109.58$82.14
Missouri
$109.54$81.95
Ohio
$109.43$81.98
South Carolina
$109.28$81.50
West Virginia
$109.18$83.06
North Carolina
$108.83$80.78
Wisconsin
$108.60$79.81
Kentucky
$107.99$81.27
Indiana
$107.95$80.08
Oklahoma
$107.62$80.77
Idaho
$107.59$79.93
Tennessee
$107.36$80.04
Nebraska
$107.34$79.60
Iowa
$107.06$79.56
Kansas
$107.01$79.83
Mississippi
$106.05$80.17
Alabama
$105.98$79.68
Arkansas
$105.07$79.25

Billed by 1 specialties

Commercial rates for 99404

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates