Medicare Physician Fee Schedule · Q3 2026 release
CPT 99204 in Queens, NY
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.
Medicare pays, Office (non-facility) setting, in Queens, NY
$201.47
Before the ~2% sequestration cut. Q3 2026 Physician Fee Schedule.
Local vs. national amount
Queens, NY pays above the national baseline by 13.6%, driven by this locality's GPCIs.
Facility setting
In a facility (e.g. hospital outpatient), Queens, NY pays $130.02 for 99204.
ZIP codes in this locality
This payment locality covers 84 ZIP codes, including 11004, 11005, 11101, 11102, 11103, 11104, 11105, 11106, 11109, 11120, 11351, 11352 and others . Every ZIP in this locality is priced the same under the Physician Fee Schedule.