CPT code 99204: Office visit, new patient, moderate complexity2026 Medicare rate & RVUs in Auburn, Washington
CPT 99204: $180.94–$198.96 office ($117.28–$124.78 facility) across 2 localities in Auburn, WA in 2026 Medicare. Compare each area.
Medicare pays $180.94–$198.96 for 99204 in the office in Auburn, Washington, from Rest of Washington to King County, WA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 6 sections
Where 99204 pays more and less in Auburn, Washington
Auburn, Washington maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | $198.96 | $124.78 |
| Rest of Washington | $180.94 | $117.28 |
How payment areas work in Auburn
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Seattle (King Cnty) · King County
- Rest Of State · Pierce County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
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.
How the rate is built · 99204
RVUs × geographic indexes × conversion factor
Work2.60
2.60 RVUs× 1.000 GPCI
Practice expense2.47
2.47 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
5.3100
Conversion factor
$33.4009
Medicare rate
$177.36
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99204
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$177.36
- Non-facility (office)
- $177.36
- Facility
- $116.90
Higher because the practice carries its own overhead.
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
Show the CMS file lines behind this rate
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