What is authorization code 99204?
Asked by: River Connelly | Last update: September 29, 2025Score: 4.3/5 (30 votes)
What qualifies for a 99204?
CPT code 99204 is a medical code used to indicate a level four office visit. This code is used when a patient has a complex medical history and requires an extensive physical examination. Code 99204 is also used when patients require counseling and care coordination with other physicians and health care professionals.
What is an example of a 99204 visit?
If you are still not feeling confident in knowing what CPT code 99204 means, consider the following patient description example. A new adult patient visiting an office, or outpatient facility, for an acute illness or injury that requires medical management. The patient may even be eligible for surgical treatment.
How much does Medicare pay for 99204?
CPT Code 99204 Reimbursement Rate (Medicare, 2025): $163.35
In the past years, this E/m code has been paid $169.93 by Medicare in 2021.
Can a physician assistant bill 99204?
If you are talking a level 4 new patient visit 99204, then it can only be billed if the patient has not been seen in your practice by any of your physicians in the last 3 years and meets level 4 criteria.
146. How Do I Document My Code?
How long is a 99204 office visit?
CPT® code 99204: New patient office visit, 45-59 minutes | American Medical Association.
When to use 99024?
99024 - Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure. Applies to surgeries with 90 and 10 day global periods.
Can a chiropractor bill 99204?
Chiropractic Manipulation with Visit
A level 4 or 5 E/M (99204, 99205, 99214, 99215) will be denied as provider liability because these levels would require significant additional work, and it is seldom appropriate to bill both.
How much does a laryngoscopy cost without insurance?
How Much Does a Diagnostic Laryngoscopy (in office) Cost? On MDsave, the cost of a Diagnostic Laryngoscopy (in office) ranges from $194 to $297.
How much is a new patient office visit?
How much does a Primary Care New Patient Office Visit cost in California? On MDsave, the cost of a Primary Care New Patient Office Visit in California, ranges from $150 to $179.
What is the difference between 92004 and 99204?
With the proper chart documentation in place, the encounter can most often be coded as 99204 (E/M code) rather than 92004 (eye code). The national average differential between the two is $16.13, favoring the E/M code (Table 2). Over time, this difference can add up for any size practice.
What is code 99213 used for?
CPT code 99213 is an evaluation and management (E/M) code for office or other outpatient visits, typically used for established patients who require a low level of medical decision-making (MDM) and management. If choosing the code based on time, the encounter involves 20 or more minutes of total time on the visit date.
What is a level 3 office visit?
Level-III visits are considered to have a low level of risk. Patient encounters that involve two or more self-limited problems, one stable chronic illness or an acute uncomplicated illness would qualify.
What is CPT code 99204?
CPT code 99204 refers to the evaluation and management (E/M) of a new patient during an outpatient/office visit. It requires moderate medical decision-making and involves a comprehensive history and/or physical examination of the patient.
Does Medicare cover 99024?
Answer: Medicare Administrative Contractors can process claims with CPT code 99024. Practitioners can put a charge on the claim.
When can a physician bill using 99050 for seeing a patient on a Saturday?
A: UnitedHealthcare will provide reimbursement for CPT code 99050 during times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service.
How many years before you can bill a new patient visit?
Three-year rule: The general rule to determine if a patient is new” is that a previous, face-to-face service (if any) must have occurred at least three years from the date of service.
What is the difference between outpatient and office visits?
The main difference between outpatient and office visits is the cost. You'll receive the same care from your doctor regardless of the facility being used, but outpatient facilities sometimes charge patients additional hospital affiliation fees.
What is CPT code 99024?
CPT 99024 — Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure.
What's the difference between a doctor and a medical practitioner?
While doctors and nurse practitioners have many similarities, there are some notable differences. The biggest difference between the two is the amount of time spent on training. While NPs have more training than a registered nurse, they receive less training than a doctor. They also are licensed differently.
Can a nurse practitioner bill for a new patient visit?
For example, if an NP conducts a visit with a new patient, the practice must make a choice -- bill the visit under the NP's provider number or bill the visit under the physician's provider number and have the physician, not the NP, perform and document the portions of the evaluation relevant to the choice of procedure ...