99204 Office outpatient new mod 45 minutes
Also known as: moderate complexity office visit, established patient visit, new patient office visit level 4, moderate complexity new visit
Office or other outpatient visit for the evaluation and management of an established patient with moderate medical decision-making complexity and an expected duration of 45 minutes.
In Plain Language
Comprehensive office visit; In-depth medical appointment
Clinical Context
Used for established patient office visits requiring moderate medical decision-making, such as management of multiple chronic conditions or more complex acute illness presentations.
RVU Breakdown
| Work RVU | 2.60 |
| Total RVU | 2.60 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 2.60, this code ranks in the 79th percentile among Evaluation & Management codes — 1.7x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99204?
CPT 99204 (Office outpatient new mod 45 minutes) is a Evaluation & Management code. Office or other outpatient visit for the evaluation and management of an established patient with moderate medical decision-making complexity and an expected duration of 45 minutes.
Who uses CPT code 99204?
CPT 99204 is used by Family Medicine, Internal Medicine, All Specialties. Used for established patient office visits requiring moderate medical decision-making, such as management of multiple chronic conditions or more complex acute illness presentations.
When is CPT 99204 used?
Used for established patient office visits requiring moderate medical decision-making, such as management of multiple chronic conditions or more complex acute illness presentations.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.