What is CPT code 99204 used for?
Asked by: Casandra Stoltenberg | Last update: June 3, 2025Score: 4.1/5 (45 votes)
What is the difference between CPT 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.
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 CPT code 99204 charge?
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.
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.
Medical Coding Practice Cases: Neurology
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.
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 the billing code for new patient office visit?
CPT® code 99203: New patient office visit, 30-44 minutes | American Medical Association.
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 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.
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 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 an example of an acute illness with systemic symptoms?
To meet the criteria for “acute illness with systemic symptoms”, the guidelines state, “systemic symptoms may not be general but may be single system”. Most influenza, pneumonia, pyelonephritis, and COVID patients would meet this criterion.
What is the age limit for CPT code 99204?
No, CPT codes 99204 and 99214 will not have age restrictions.
Is 99204 covered by Medicare?
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.
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.
Is there a fee for CPT 99024?
CPT® 99024 is a Medicare bundled code with zero relative value units (RVUs) and no fee on the Medicare Physician Fee Schedule (MPFS), so you may wonder why CMS is interested in collecting this data. In fact, a Medicare bundled code is reimbursed by Medicare, but not at the time the service is performed.
What is the 57 modifier used for?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
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.
What is the 3 year rule for new patients?
By CPT definition, a new patient is “one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.” By contrast, an established patient has received professional services from the physician or ...
What does level 5 patient mean?
PUBLISHED on JULY 20, 2023. If you visit the emergency room, your bill will typically include a "ER visit level" line item that's based on the complexity of your treatment. A Level 5 emergency room visit, or ER visit level 5, is reserved for the most severe cases.
What is medical complexity 99204?
Moderate complexity medical decision making: Codes 99204 and 99214 include two or more stable chronic illnesses, one or more chronic illnesses with exacerbation, progression, or side effects of treatment, one undiagnosed new problem with uncertain prognosis, one acute illness with systemic symptoms, or one acute ...