CPT Code 99204: Office visit, new patient, moderate-high complexity

When to Use CPT 99204

Use CPT code 99204 when billing for office visit, new patient, moderate-high complexity. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.

Adding CPT 99204 to a Superbill

When generating a superbill with CPT 99204, include the ICD-10 diagnosis code, date of service, fee charged, amount paid, and your NPI number. Superbilled pre-fills common therapy CPT codes automatically.

Common ICD-10 Pairings

These diagnosis codes are frequently used alongside CPT 99204:

Documentation Requirements

Document moderate-high complexity medical decision making with multiple diagnoses or management options. Include thorough data review and risk assessment.

Common Denial Reasons

• ✗ Complexity documented does not meet moderate-high threshold
• ✗ Time-based billing without adequate total time documentation
• ✗ Downcoded to 99203 due to insufficient supporting data

Got one of these on a remittance? Decode the denial code.

Reimbursement Expectations

OON reimbursement typically 50-70% of UCR. Expect $80-$195 from commercial insurers.