What is code 99204 used for?
Asked by: Erick O'Hara | Last update: May 22, 2025Score: 4.4/5 (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 patient?
Typical patient description
Office visit for a new patient with a progressing illness or acute injury that requires medical management or potential surgical treatment.
What is CPT code 99204 charge?
CPT code 99204 is designated for new patient office or outpatient visits that require a moderate complexity in medical decision-making or 45-59 minutes of patient encounter time. Proper documentation and accurate code selection are crucial for maximizing reimbursement with CPT code 99204.
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.
What is a level 4 office / outpatient visit in medical coding? 99214 & 99204 explained.
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.
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.
What is the difference between CPT code 99204 and 99205?
Code 99204 requires a minimum of 45 minutes of face-to-face time with the patient and Code 99205 requires a minimum of 60 minutes face-to-face time with the patient. For both services, at least 50% of the face-to-face time must be spent providing counseling and/or coordination of care.
What two factors may be considered in assigning an outpatient visit code?
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making.
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 the CPT code for a new patient?
New Patient CPT® Code range 99202- 99205.
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.
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.
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.
How painful is a laryngoscopy?
The tube may be flexible or stiff. This procedure allows your provider to see deeper in the throat and to remove a foreign object or sample tissue for a biopsy. It is done in a hospital or medical center under general anesthesia, meaning you will be asleep and pain-free.
What type of doctor performs laryngoscopy?
Ear, nose, and throat specialists (also called ENT doctors or otolaryngologists) do laryngoscopies. They can do: an indirect laryngoscopy: The doctor uses a small mirror and a light to examine the larynx and vocal cords.
What are the rules for 99204?
CPT code 99204: New patient office visit, minimum 45 minutes
When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. As a prescriber, you can bill insurance according to time or medical decision-making (MDM).
What is a 99204 charge?
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.
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.
Is surgery free with Medicaid?
In almost every case, an emergency surgery qualifies for coverage through Medicaid services. If an elective or cosmetic surgery is deemed medically necessary, it can also be approved.
What is the difference between CPT code 99204 and 99214?
The total time needed for a level 4 visit with an established patient (CPT code 99214) is 30–39 minutes. The total time needed for a level 4 visit with a new patient (CPT 99204) is 45–59 minutes. Many EHRs have time calculators that will show the amount of time you have had the patient's chart open.