Is CPT 99204 overcharged?
99204: Office visit, new patient, moderate complexity (Office visit)
Approximate Medicare national rate
$177.36
Source: CMS Physician Fee Schedule CY2026, Oct release (national, non-facility). National amount; actual Medicare payment varies by locality. Facility-setting physician rate: $116.90 (hospital facility fee billed separately).
What's a reasonable charge?
Commercial insurers typically pay roughly 1.5 to 2.5 times Medicare. If you were billed more than $532.08 for 99204, ask for an itemized bill, request the provider's cash price, and dispute the difference.
Check your whole bill
Duplicates and unbundling are often worth more than a single high price. Scan your bill free