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CPT Code 99204: New Patient E/M Billing Guide


Among the numerous Evaluation and Management (E/M) codes, 99204CPT Code holds particular significance for healthcare providers seeing new patients in an office or outpatient setting. Proper use of this code ensures appropriate reimbursement for moderately complex services that require comprehensive documentation and clinical decision-making.

This article provides a comprehensive overview of CPT 99204—its definition, time and medical necessity requirements, documentation elements, common billing errors, and how to optimize claims for successful reimbursement.

What is 99204 CPT Code?

99204 CPT code is part of the E/M coding family and is specifically used for new patient office or outpatient visits that involve a moderate level of medical decision-making (MDM) or a total time of 45-59 minutes spent with the patient on the date of the encounter.

Key Definition:

99204 – 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 time for code selection, 45-59 minutes of total time is spent on the date of the encounter.

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