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?