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99204

Office or other outpatient visit for the evaluation and management of a new patient, typically 45 minutes.

Code Description

CPT code 99204 is used for office or outpatient evaluation and management visits involving a new patient. This code typically represents a moderate level of medical decision making and approximately 45 minutes of total time spent on the date of the encounter.

Healthcare providers commonly report CPT 99204 for visits requiring detailed evaluation, management of multiple conditions, review of outside records, and moderate risk treatment planning.

When to Use 99204

Use CPT 99204 for moderate-complexity new patient office visits involving more extensive evaluation and medical decision making.

Common examples include:

  • multiple chronic conditions

  • worsening symptoms

  • moderate risk treatment decisions

  • extensive diagnostic review

  • prescription medication management

Documentation Requirements

Documentation should include:

  • medically appropriate history

  • medically appropriate examination

  • moderate medical decision making

  • documented encounter time when billing based on time

Common Billing Mistakes

Common billing mistakes for CPT 99204 include:

  • insufficient documentation for moderate complexity

  • incorrect time reporting

  • missing treatment plan details

  • using 99204 for low complexity visits

Related CPT Codes

99202- Office or other outpatient visit for a new patient, typically 15 minutes.

99203- Office or other outpatient visit for a new patient, typically 30 minutes.

99205- Office or other outpatient visit for a new patient, typically 60 minutes.

FAQ

Is CPT 99204 for new patients only?

Yes. CPT 99204 is used only for new patient office or outpatient visits.

What is the typical time for CPT 99204?

The typical total time for CPT 99204 is 45 minutes.

What level of medical decision making is required?

CPT 99204 requires moderate medical decision making.

Can CPT 99204 be billed using time?

Yes. Providers may bill CPT 99204 using total encounter time when properly documented.

Patient Type

New Patient

Typical Time

MDM Level

45 Minutes

Moderate