CPT 99204
CPT Code 99204: Office visit, new patient, moderate-high complexity
Duration
45-59 min
Typical Fee
$160-$280
Type
Outpatient therapy
Note: New patient E/M.
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
Reimbursement Expectations
OON reimbursement typically 50-70% of UCR. Expect $80-$195 from commercial insurers.