CPT 99204: Office/Outpatient Visit — New Patient, Level 4
A new-patient office visit with high complexity medical decision making, typically a comprehensive intake.
Category: Office Visit | Typical bill: $180 - $400
⚠️ Prior authorization: No
🎯 Am I being overcharged?
Enter what your bill says for CPT 99204 and we'll flag it against a typical fair range for this service.
Why your Office/Outpatient Visit — New Patient, Level 4 bill looks so high
Hospitals bill a "rack rate" that is often 2-10x higher than what Medicare pays or what insurers actually reimburse. The fair range for CPT 99204 is roughly $180 - $400 — but many facilities bill far beyond it.
Common reasons 99204 claims get denied
- New patient status wrongly assigned to established patient. 'New patient' means no service from this group in 3 years. If you've been seen recently it must be an established code (lower cost).
If you've seen this provider group within 3 years, you cannot be charged a 'new patient' rate.
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