What is office visit code 99204?
Asked by: Prof. Boyd Jacobson PhD | Last update: September 4, 2025Score: 4.2/5 (55 votes)
What is code 99204 used for?
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.
What type of exam is required for a 99204?
For a 99204, all three major criteria (history, physical exam and medical decision making) must be met. A 99214 requires only two of the three major criteria. For a 99204, the review of systems must include at least 10 systems or body areas.
How long is a 99204 visit?
CPT® code 99204: New patient office visit, 45-59 minutes | American Medical Association.
What is a level 4 office / outpatient visit in medical coding? 99214 & 99204 explained.
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.
Does Medicare pay for 99204?
The Medicare reimbursement rate for CPT code 99204 in 2024 is set at $167.10. Code 99204 is the most popular code for billing new patients seen in the office, with internists choosing it for 49.61% of these types of encounters.
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 does insurance pay for a 99214?
The current reimbursements for code 99214 at two of the most popular programs are: Medicare: $126.07. Medicaid: $68.97.
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.
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 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.
How many minutes is 99214?
CPT® code 99214: Established patient office visit, 30-39 minutes | American Medical Association.
What is the procedure code for a physical exam?
The Current Procedural Terminology (CPT®) code 2040F as maintained by American Medical Association, is a medical procedural code under the range - Physical Examination.
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 is the average payment 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 you bill an office visit and hospital visit on the same day?
CPT Codes 99221-99223, 99231-99236, 99238 & 99239
MACs pay both visits if you see a patient in the office on 1 day, and they're admitted to the hospital as an inpatient or get observation care on the next day.
How much does Medicare Part B pay for physician fees?
Medicare pays 80% of the approved charge. Either the patient or supplemental insurance pays the remaining 20% co-payment. No further payment is due to the physician. When a physician does not accept assignment, however, he or she may “balance bill” the patient above the Medicare approved charge.
What does modifier 79 mean?
Modifier 79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period of the original surgery. When the procedure is related to the original surgery or is a staged (anticipated) surgery, it falls under the global period and should not use Modifier 79.
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.
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.