$138.86–$153.12
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.
On this page
CMS RVU26D · Effective 2026-10-01
99204 Office visit Medicare reimbursement rates in Washington
Office or outpatient visit for a new patient reported for moderate medical decision making or at least 45 minutes of practitioner time on the visit date. Compare 99204 office and facility rates across CMS payment localities in Washington.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99204 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$180.94–$198.96
2 of 2 localities have a supported rate.
Facility setting
$117.28–$124.78
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Evaluation and management
About 99204: New patient office visit, moderate complexity
Office or outpatient visit for a new patient reported for moderate medical decision making or at least 45 minutes of practitioner time on the visit date.
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.
Where the value comes from
- Work RVU2.60 · 49%
- Practice expense (office) RVU2.47 · 47%
- Malpractice RVU0.24 · 5%
12.7M
Medicare services in 2024 · #17 by national volume
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.
99204 compared with similar codes
Office rates for Washington, from the same CMS release.
$241.18–$264.95
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.
99244
No office rateOff/op cnsltj new/est mod 40
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.
$120.10–$132.61
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.
Compare 99204 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
$180.94
Facility
$117.28
Seattle (King Cnty) →
Office / nonfacility
$198.96
Facility
$124.78
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Primary care
Compare office and outpatient evaluation-and-management base rates.
99204 billing questions
When should 99204 be chosen over 99203 or 99205?
Choose 99204 for moderate MDM or at least 45 minutes when selecting by time. The corresponding thresholds are low MDM or 30 minutes for 99203, and high MDM or 60 minutes for 99205.
Can prolonged service time be added to 99204?
No. For Medicare office and outpatient E/M, G2212 pairs with 99205 only when its prolonged-time requirements are met; it cannot be reported with 99204.
What makes a patient new for this code?
The patient must not have received a professional face-to-face service from the same practitioner or a same-specialty, same-subspecialty colleague in the same group within the prior three years. A patient seen by a different specialty in the group can still be new.
Which modifier applies if a procedure is done at the same visit?
Append modifier 25 when the visit is significant and separately identifiable from a same-day procedure. Use modifier 57 when the visit results in the decision for major surgery.
Can G2211 be reported with 99204 for Medicare?
Yes, when the practitioner is the continuing focal point for the patient's care or provides ongoing care for a serious or complex condition. It generally cannot be reported with a modifier 25 visit, with limited exceptions for certain Medicare preventive services.
Does Medicare accept consult code 99244 instead of 99204?
Medicare does not pay office consultation codes. Report an appropriate office or outpatient visit code instead; choose 99204 only when the patient is new and the MDM or time supports that level.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,00899199,,Unlisted special svc px/rprt,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,00999202,,Office o/p new sf 15 min,A,,0.93,1.25,,0.23,,0.07,2.25,1.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01099203,,Office o/p new low 30 min,A,,1.60,1.76,,0.38,,0.16,3.52,2.14,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01199204,,Office o/p new mod 45 min,A,,2.60,2.47,,0.66,,0.24,5.31,3.50,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01299205,,Office o/p new hi 60 min,A,,3.50,3.23,,0.94,,0.36,7.09,4.80,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01399211,,Off/op est may x req phy/qhp,A,,0.18,0.54,,0.04,,0.01,0.73,0.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01499212,,Office o/p est sf 10 min,A,,0.70,1.02,,0.17,,0.06,1.78,0.93,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00