Office & outpatient visits
99204 - RVUs & Medicare payment (2026)
Office visit, new patient, level 4 (moderate complexity, 45-59 min).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 2.60 | 2.60 |
| Practice expense RVU | 2.47 | 0.66 |
| Malpractice RVU | 0.24 | 0.24 |
| Total RVUs | 5.31 | 3.50 |
| National payment (CF $33.4009) | $177.36 | $116.90 |
| Qualifying APM payment (CF $33.5675) | $178.24 | $117.49 |
How 99204 payment varies by locality
Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99204 ranges from $161.84 in Arkansas (AR) to $222.54 in Alaska (AK); calculate 99204 for your locality.
Global period: XXX
No global period: the global surgery concept does not apply to this code.
Related codes - office & outpatient visits
- 99202 · office visit, new patient, level 2 (straightforward, 15-29 min)
- 99203 · office visit, new patient, level 3 (low complexity, 30-44 min)
- 99205 · office visit, new patient, level 5 (high complexity, 60-74 min)
- 99211 · office visit, established patient, level 1 (minimal, staff-level)
- 99212 · office visit, established patient, level 2 (straightforward, 10-19 min)
- 99213 · office visit, established patient, level 3 (low complexity, 20-29 min)
- 99214 · office visit, established patient, level 4 (moderate complexity, 30-39 min)
- 99215 · office visit, established patient, level 5 (high complexity, 40-54 min)
- G2212 · medicare prolonged visit add-on, each additional 15 minutes
- G2211 · medicare add-on for visit complexity in continuing, longitudinal care
Frequently asked questions
How much does Medicare pay for 99204 in 2026?
What is the work RVU for 99204?
Why are the facility and non-facility amounts different?
Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.