How to Bill CPT 99204 for Office and Outpatient E/M Visits

When to Use CPT Code 99204

CPT 99204 is used for office or outpatient evaluation and management (E/M) services.

• •Patient type: Office visit for new patient, moderate complexity
• •Service type: Office or outpatient visit
• •Billing basis: Medical decision making or total time

Common scenarios:

• •New patient evaluations
• •Established patient follow-ups
• •Chronic condition management

Insurance Verification Tips for CPT 99204

1. •Confirm patient status (new vs established).
2. •Select code based on medical decision making or total time.
3. •Ensure documentation supports complexity level.
4. •Avoid undercoding or overcoding risk.

Example Case of CPT 99204

A provider conducts an office visit addressing the patient’s clinical concerns and documents the appropriate history, decision making, and time.
The visit is billed as one unit of CPT 99204.