Last updated: July 2026CMS rates · Free lookup

Medicare Fee Schedule Lookup

Search 2026 Medicare reimbursement rates and national payment amounts by CPT, HCPCS, or MS-DRG code. The lookup includes the Physician Fee Schedule, Drug ASP, MS-DRG weights, anesthesia conversion factors, and Clinical Laboratory Fee Schedule data from CMS.

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10+

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HCPCS Codes

99204

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Year

2026

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Physician Fee Schedule·99204·National·2026

Current non-facility rate

$177.36▲0.0%

Facility: $116.90

Code description

Office O P New Mod 45 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded

Code	Date	State	Non-Facility Fee	Facility Fee	Description
99204	7/2026	N/A	$177.36	$116.90	Office O P New Mod 45 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded
99204	4/2026	N/A	$177.36	$116.90	Office O P New Mod 45 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded
99204	1/2026	N/A	$177.36	$116.90	Office O P New Mod 45 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded

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Medicaid comparison

State Medicaid programs pay a median of $128.18 for 99204

Across 47 state fee schedules the rate runs from $68.90 in CA to $309.91 in AK - a 4.5x spread. Free to explore state by state.

16,416 codes and 616,564 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99204

$75.15

99203Office O P New Low 30 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded

$117.57

99205Office O P New Hi 60 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And High Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded

$236.81

Methodology

Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.

View CMS Physician Fee Schedule