CPT code 99204: Office visit, new patient, moderate complexity2026 Medicare rate & RVUs in Houston, TX

In Houston, TX, Medicare pays $180.49 for 99204 in the office and $120.46 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99204 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99204 covers

This office or outpatient visit is for a patient who has not received professional services from the practitioner, or another practitioner of the same specialty and subspecialty in the same group, within the past three years. Physicians, nurse practitioners, and physician assistants may perform it in offices, clinics, and hospital outpatient departments. The history and examination should be medically appropriate but do not determine the visit level. Two stable chronic illnesses, a chronic illness with exacerbation, or an undiagnosed new problem with uncertain prognosis may establish the moderate problems element; prescription drug management may establish the moderate risk element.

Select 99204 by moderate medical decision making, which requires two of the three MDM elements at the moderate level, or by at least 45 minutes of practitioner time on the encounter date. Count qualifying face-to-face and non-face-to-face work, such as reviewing outside records, ordering tests, and documenting. Exclude clinical staff time and time spent on separately reported services. If selecting by time and the 99205 threshold of 60 minutes is met, report 99205 instead. Document the supporting MDM elements or total time and activities performed.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Houston, TX compares for 99204

Across 109 of 109 payment localities, the office rate for 99204 runs from $161.84 in Arkansas to $222.54 in Alaska. Houston, TX pays $180.49. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99204 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99204 in every payment locality

How the 99204 rate is calculated

Each of 99204’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99204

99204 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.

99204 compared with similar codes

Same family in Houston, TX

How to choose

99214Office visitEstablished patient, moderate complexity

Both permit selection by moderate MDM. Use 99214 for an established patient or 99204 for a new patient; their respective time thresholds are 30 and 45 minutes.

99205Office visitNew patient, high complexity

99205 is selected for high MDM or, when selecting by time, at least 60 minutes. Use 99204 for moderate MDM or when its 45-minute time threshold is the highest one met.

99244Office consultationModerate level

99244 is an office consultation that may involve a new or established patient. Medicare does not pay it; for a new Medicare patient, choose 99204 only if the MDM or time supports that level.

99203New patient visitLow MDM or 30 minutes

99203 fits low MDM or a 30-minute time threshold. Multiple stable chronic illnesses or prescription drug management can establish one moderate MDM element; 99204 requires two moderate elements when selected by MDM.

Codes related to 99204

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99204 has changed in Houston, TX

Price 99204 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

• 99204 in Houston · multiple payment areas
• Aldine
• Atascocita
• Barrett
• 99204 in Baytown · multiple payment areas
• Bellaire
• Bunker Hill Village
• Channelview

Browse all communities in Texas

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates