If you’re familiar with medical billing and coding, you may have heard of the 99204 CPT code. This code is commonly used by healthcare providers to bill for complex office visits, and it’s an important code to understand if you’re in the healthcare industry. In this article, we’ll give you a brief description of the 99204 CPT code and its uses.

What is the 99204 CPT code?

The 99204 CPT code is used for billing a new patient office visit that involves a detailed history, a detailed examination and medical decision making of moderate complexity. This code is part of the Current Procedural Terminology (CPT) code set, which is a system used by healthcare providers and insurance companies to identify and bill for medical services.

When should the 99204 CPT code be used?

The 99204 CPT code should be used when a healthcare provider provides a comprehensive evaluation and management service to a new patient. This code can only be used if the physician provides a detailed history taking, a detailed examination and moderate medical decision making. A patient who has been seen by the same physician before cannot be billed under this code.

What is included in the 99204 CPT code?

The 99204 CPT code includes a comprehensive evaluation and management service provided by the physician. This includes a thorough history taking, a comprehensive examination and a medical decision making process of moderate complexity. The medical decision making process may involve ordering or reviewing medical tests, referring the patient to other healthcare providers, or providing advice and treatment recommendations.

How is the 99204 CPT code billed?

The 99204 CPT code is billed as an evaluation and management service, using the appropriate billing code. Healthcare providers may also bill for any necessary medical tests or procedures that were performed during the visit, in addition to the evaluation and management service.


The 99204 CPT code is an important code for healthcare providers to understand if they bill for office visits. This code is used for comprehensive evaluation and management services provided to a new patient, and it includes a detailed history taking, examination and moderate complexity medical decision making. If you’re a healthcare provider, it’s important to ensure proper documentation to support the use of the 99204 CPT code.

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