CPT® 99204: new patient office visit, moderate MDM

CPT® 99204 reports an office or other outpatient visit for a new patient. Since 2021 it is selected by one of two paths: moderate medical decision making, or at least 45 minutes of the practitioner’s total time on the date of the encounter.

Patient: New
Medical decision making: Moderate
Minimum total time: 45 minutes (2021 range 45–59)
Same level, established patient: 99214
One level down: 99203
One level up: 99205

Selecting 99204 by medical decision making

MDM has three elements: the number and complexity of problems addressed, the amount and/or complexity of data to be reviewed and analyzed, and the risk of complications and/or morbidity or mortality of patient management. To report 99204, two of the three must meet or exceed the moderate level. The AMA's Table 2 defines that level as follows; the data element has its own category rules, listed in the source.

What the moderate level looks like for each MDM element
Element	Moderate level
Problems addressed	1 or more chronic illnesses with exacerbation, progression, or side effects of treatment 2 or more stable chronic illnesses 1 undiagnosed new problem with uncertain prognosis 1 acute illness with systemic symptoms 1 acute complicated injury
Data reviewed and analyzed	Moderate (must meet 1 of 3 categories)
Risk of patient management	Moderate risk of morbidity from additional diagnostic testing or treatment Prescription drug management Decision regarding minor surgery with identified patient or procedure risk factors Decision regarding elective major surgery without identified patient or procedure risk factors Diagnosis or treatment significantly limited by social determinants of health

Selecting 99204 by time

When the level is selected by time, 99204 requires at least 45 minutes of the physician's or qualified health care professional's total time on the date of the encounter, face-to-face and non-face-to-face. The 2021 code set listed it as 45–59 minutes; the current CPT® code set is the authority for the exact descriptor. Activities that count, and the ones that do not, are listed in the total time section of the guide.

What the note has to show

Because two of the three elements must be met, a note that supports 99204 by MDM has to make at least two of them visible at the moderate level: the problems addressed and their status, the data reviewed or ordered, or the management decisions that carry the risk. A note that supports 99204 by time has to record the total time on the date of the encounter. The MedChartScan E/M audit reads the note for these elements and shows the passages it used, so the level can be checked against the text before the claim goes out.

Nearby codes

Same level for an established patient: 99214
One level down: 99203
One level up: 99205
All office and outpatient codes: the code table in the guide

Questions

How many minutes is 99204?

When the level is selected by time, 99204 requires at least 45 minutes of the practitioner’s total time on the date of the encounter; the 2021 code set listed it as 45–59 minutes. The level can also be reached by moderate medical decision making regardless of time.

What level of medical decision making is 99204?

Moderate. Two of the three MDM elements (problems addressed, data reviewed and analyzed, and risk of patient management) must meet or exceed the moderate level.

Is 99204 for new or established patients?

New patients. The established-patient code at the same level is 99214.

Sources

CPT® Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services code and guideline changes, effective January 1, 2021 (opens in a new tab) — American Medical Association (with March 9, 2021 technical corrections)
Evaluation and Management Services (MLN006764), May 2026 revision (opens in a new tab) — Centers for Medicare & Medicaid Services

Last reviewed September 29, 2026 · CPT® is a registered trademark of the American Medical Association · Full guide: How E/M coding works