CPT 99204 Evaluation & Management
Office o/p new mod 45 min Cost
Body System: General
Medicare Facility Rate
$117
CMS PFS CY2026
Medicare Non-Facility Rate
$177
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
2.60
Work RVU
0.66
Facility PE RVU
0.24
Malpractice RVU
5.31
Total RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $159 | $291 — $447 |
| AZ — ARIZONA | $116 | $227 — $349 |
| CA — BAKERSFIELD | $118 | $240 — $369 |
| CA — CHICO | $117 | $239 — $368 |
| CA — EL CENTRO | $117 | $239 — $368 |
| CA — FRESNO | $117 | $239 — $368 |
| CA — HANFORD-CORCORAN | $117 | $239 — $368 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $122 | $253 — $389 |
| CA — MADERA | $117 | $239 — $368 |
| CA — MERCED | $117 | $239 — $368 |
| CA — MODESTO | $117 | $239 — $368 |
| CA — NAPA | $126 | $268 — $412 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $121 | $251 — $385 |
| CA — REDDING | $117 | $239 — $368 |
| CA — REST OF CALIFORNIA | $117 | $239 — $368 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $120 | $243 — $373 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $121 | $249 — $382 |
| CA — SALINAS | $120 | $248 — $381 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $121 | $251 — $387 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $131 | $281 — $432 |
Frequently Asked Questions
How much does Office o/p new mod 45 min cost?
The Medicare facility rate is $117. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Office o/p new mod 45 min cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $117.