Office visit · CPT 99204

What is CPT code 99204?

New-patient office visit, moderate complexity.

By Justin Feldstein · Reviewed 2026-06-15

What it covers

A first visit that involves a detailed history, a thorough exam, and moderate-complexity decision-making. This is common when you're establishing care for a genuine ongoing problem, several issues at once, or anything that needs a real plan rather than quick reassurance. It's one of the more frequently billed new-patient levels because specialists and primary-care doctors both use it when a first appointment covers a lot of ground.

When you'd see it

Your first appointment with a specialist, or a new-patient visit where multiple concerns or a real diagnosis get worked through.

Roughly what it costs

$230–$430 commonly billed

A ballpark on the billed amount. After insurance or a negotiated rate, what you owe is often far lower. Always compare against your Explanation of Benefits (EOB).

What's usually billed with it

Frequently accompanied by labs, imaging, or an EKG (93000) when the new provider starts a workup; those are separate, legitimate line items.

99204 vs 99205

99205 is reserved for the most complex or highest-risk first visits, so a typical detailed new-patient visit lands at 99204, not the top level. See 99205 (new-patient, high complexity).

What to watch for

New-patient levels are easy to over-bill. If the appointment was brief or covered just one simple issue, it's reasonable to ask why it wasn't coded as the lower 99203.

Specific things to question

• Whether the visit truly involved moderate-level decision-making, or was simpler than 99204 implies.
• Whether you qualified as a new patient (no visit to the practice in three years).
• Whether it was billed at 99205 when the visit didn't reach high complexity.

How to check this charge on your own bill

Find 99204 on your itemized bill and match it against your EOB. Confirm it appears only once, that any bundled services aren't also billed separately, and that the amount matches what your insurer says it allowed. If something doesn't line up, that's a fair question for the billing office.