CPT 99204: office visit, new patient, level 4. What Medicare pays and what to ask
The first visit with a new doctor is billed at a higher level. Here is what 99204 means and the Medicare rate.
What this code means
CPT 99204 is a visit with a new patient (not seen by the same practice and specialty in the last three years) with moderate medical decision making, or at least 45 minutes of total time.
It sits one level above 99203 and below 99205.
Why the bill can be much higher than the Medicare rate
A visit level is chosen by the clinician and the practice's coders, so two similar visits can be billed differently.
If the office is owned by a hospital, a separate facility fee may also appear.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $886.80 |
| 10x the Medicare rate | $1,773.60 |
| 20x the Medicare rate | $3,547.20 |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- Was I really a new patient to this practice?
- Why was level 4 used rather than level 3?
- Is there a facility fee on this bill, and why?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Physician Fee Schedule (CMS, July 2026 release), national payment amount, non-facility setting. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.