CMS October 2026Physician Fee Schedule · Free lookup

CPT 99204 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 99204 is $177.36 in a non-facility setting ($116.90 in a facility), up 8.6% from $163.35 in 2025.

Non-facility: $177.36
Facility: $116.90
vs. 2025: +8.6%

CMS 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

99204 national rate by year

Each row is the latest CMS file published that year. Change is against the year before.

CMS file	Non-facility	Facility	Change
October 2026	$177.36	$116.90	+8.6%
October 2025	$163.35	$129.06	-2.2%
March 2024	$167.10	$132.15	-0.2%
January 2023	$167.40	$133.52	-1.3%
July 2022	$169.57	$136.69	-

This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower. The facility amount applies when the service is performed in a hospital or other facility setting.

Medicaid comparison

State Medicaid programs pay a median of $134.57 for 99204

Across 45 state fee schedules the rate runs from $69.90 in NH to $309.91 in AK - a 4.4x spread. That median is 76% of Medicare's $177.359 national non-facility rate. Free to explore state by state.

17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99204

Commercial payers publish their negotiated rates for 99204 in transparency files. See how those compare with Medicare's rate.

Commercial rates for 99204

PayerPrice Platform

Compare Medicare's rate for 99204 with published commercial rates

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Nearby codes

99202 Medicare rate 99203 Medicare rate 99205 Medicare rate 99211 Medicare rate 99212 Medicare rate 99213 Medicare rate

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