# CPT 99204

> Medicare paid $166.73 for CPT 99204 in the office (non-facility) setting and $131.88 in a facility under the Q4 2015 Physician Fee Schedule, effective October 2015. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.5% increase from the previous quarter.

## What it is

A moderate-complexity visit for a new patient — for example, establishing care for someone with two or more chronic conditions, or evaluating a new problem such as unexplained weight loss that needs further work-up. Total visit time typically runs about 45 to 59 minutes, and documentation should reflect a more detailed history, moderate data review, and moderate risk from the plan of care.

## Selected release

- Release: Q4 2015 (2015 D)
- Effective: October 1 – December 31, 2015
- Status indicator: A
- Office (non-facility) national allowed amount: $166.73
- Facility national allowed amount: $131.88
- Sequestration: not applied

## RVUs and formula

- Work RVU: 2.43
- Office (non-facility) practice expense RVU: 1.99
- Facility practice expense RVU: 1.02
- Malpractice RVU: 0.22
- Conversion factor: 35.9335
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q4 2015)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu15d.zip
- Parsed file: PPRRVU15_OCT05_V1001.csv, row 15,932
- Canonical page: https://localishealth.com/cpt/99204/2015/D
- Release-specific citation URL: https://localishealth.com/cpt/99204/2015/D
- Last significant update: 2026-08-04T03:06:14+00:00