PFS ExplorerMedicare Physician Fee Schedule · 2026

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99204

Office o/p new mod 45 min

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Code typePrimary
Payment statusActive (A)
Global periodNone

Pricing with Related Codes

Line
Qty
Global fee
Pro fee
Primary99204Office o/p new mod 45 min
1
$177.36
$116.90
Add-on15853Removal sutr/stapl xreq anes
0
$13.36/ unit
$13.36/ unit
Add-on15854Removal sutr&stapl xreq anes
0
$17.70/ unit
$17.70/ unit
Add-on90833Psytx w pt w e/m 30 min
0
$81.50/ unit
$65.80/ unit
Add-on90836Psytx w pt w e/m 45 min
0
$103.21/ unit
$83.17/ unit
Add-on90838Psytx w pt w e/m 60 min
0
$136.61/ unit
$110.22/ unit
Add-on96160Pt-focused hlth risk assmt
0
$3.01/ unit
$3.01/ unit
Add-on96161Caregiver health risk assmt
0
$3.34/ unit
$3.34/ unit
Add-on99415Prolng clin staff svc 1st hr
0
$23.05/ unit
$23.05/ unit
Add-on99459Pelvic examination
0
$17.37/ unit
$17.37/ unit
Add-onG0506Comp asses care plan ccm svc
0
$66.47/ unit
$38.41/ unit
Add-onG2211Complex e/m visit add on
0
$17.37/ unit
$14.36/ unit
Whole procedure · 2.60 wRVU credited
$177.36
$116.90

RVU Breakdown

Component
Office
Facility
Work
2.60
2.60
Practice expense
2.47
0.66
Malpractice
0.24
0.24
Total RVU
5.31
3.50

Payment Policy & Modifiers

Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66Prof / tech split