# CPT 99204

> The national PFS baseline is $177.36 for CPT 99204 in the office (non-facility) setting and $116.90 in a facility under the Q3 2026 Physician Fee Schedule, effective July 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded. Across payment localities, the office amount is $161.84–$222.54 and the facility amount is $109.91–$158.16. This price has been unchanged since Q1 2026, when it increased 8.6%.

## What it is

Long New Patient Office Visit

## Selected release

- Release: Q3 2026 (2026 C)
- Effective: July 1 – September 30, 2026
- Status indicator: A
- Office (non-facility) national allowed amount: $177.36
- Facility national allowed amount: $116.90
- Sequestration: not applied

## RVUs and formula

- Work RVU: 2.60
- Office (non-facility) practice expense RVU: 2.47
- Facility practice expense RVU: 0.66
- Malpractice RVU: 0.24
- Conversion factor: 33.4009
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## NCCI edits

- Never-billable pair count: 384
- Modifier-allowed pair count: 350
- MUE units per patient per date of service: not published
- Complete list: https://localishealth.com/cpt/99204/ncci-edits.txt

## Source and citation

- Source: Physician relative value file (Q3 2026)
- CMS file: https://www.cms.gov/files/zip/rvu26c-updated-06-30-2026.zip
- Parsed file: PPRRVU2026_Jul_nonQPP.csv, row 12,950
- Canonical page: https://localishealth.com/cpt/99204
- Release-specific citation URL: https://localishealth.com/cpt/99204/2026/C
- Last significant update: 2026-08-13T15:22:50+00:00