CPT 99204 is a new-patient office visit of moderate complexity, around 45 minutes: several problems, a chronic condition being evaluated, or a decision about prescription treatment. It is the most commonly billed new-patient level in specialty practices.

What the price covers

When listed by a hospital, this is the price at a hospital-owned clinic or outpatient department, which may add a facility fee on top of the clinician's professional fee. Tests, imaging and procedures are separate.

Why prices vary

The same 45 minutes with a physician can cost two or three times more at a hospital-owned practice than at an independent one, mostly because of the facility fee. Within hospitals, prices follow system size. Cash prices are usually well below gross charges.

Questions to ask

What is the self-pay price for 99204, and is there a facility fee?
Is the visit at a hospital outpatient department or an independent office?
What level will be billed if the visit takes longer or is more complex?

New patient office visit (about 45 minutes) near you