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99204 Medicare Reimbursement Rate (2026)

Current CMS pricing and breakdown for Office o/p new mod 45 min.

CPT Code 99204

National Average Payment

Non-Facility (Private Office) Rate

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$177.35
Effective Jan 1, 2026

⚠️ This is a National Estimate

Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).

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Code Description

Office o/p new mod 45 min

2026 Breakdown

ComponentOffice (Non-Fac)Facility (Hosp)
Work RVU2.62.6
Practice Expense (PE)2.470.66
Malpractice (MP)0.240.24
Total RVUs5.313.50

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Nearby Codes

9920399205