CPT 99204 Office Visit

Office Visit — New Patient (Moderate-High)

What should this cost?

Medicare Pays

$170

National benchmark

Typical Range

$300–$600

What hospitals charge

Markup

Above Medicare rate

What this code means on your bill

A comprehensive new patient visit lasting 45-59 minutes. Involves extensive history-taking, examination, and complex decision-making.

Commonly billed for

Complex new patient evaluations, multiple complaints, detailed workup needed

What to watch for

Upcoding

If your visit seemed straightforward but you see a high-level code, the provider may have billed for a more complex service than what was performed. Compare the code level to the time you actually spent with the doctor.

Duplicate charges

Check if this code appears more than once on the same date of service. Unless you had the same procedure performed twice (rare), a duplicate is likely a billing error.

Price check

If you're being charged more than 720 for this service, it's significantly above the typical range. Request an itemized bill and compare against the Medicare rate of $170.

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Related billing codes

99202

Office Visit — New Patient (Low)

Medicare: $67

99203

Office Visit — New Patient (Moderate)

Medicare: $111

99205

Office Visit — New Patient (High Complexity)

Medicare: $211

99211

Office Visit — Established Patient (Minimal)

Medicare: $23