CPT 99204 is a new patient office or outpatient E/M code. In the imported 2026 CMS RVU data set used by RVUinUSA, 99204 carries 2.60 work RVU, 2.47 non-facility practice expense RVU, 0.66 facility practice expense RVU, and 0.24 malpractice RVU before GPCI and conversion factor assumptions. That makes it an important reference code for new patient access, specialty intake visits, referral-heavy clinics, and physician compensation modeling. This page explains the RVU and payment effect after 99204 is supported by documentation and payer rules; it is not coding advice and does not determine whether a specific visit should be coded as 99204.
99204 in the 2026 RVU data set
The imported 2026 descriptor for 99204 is a moderate-level new patient office or outpatient visit with a 45-minute reference descriptor. For RVU modeling, the core components are 2.60 work RVU, 2.47 non-facility practice expense RVU, 0.66 facility practice expense RVU, and 0.24 malpractice RVU. Those values are useful for payment estimates, productivity analysis, and contract review only after the E/M level is independently supported. The RVU table should not be used as a shortcut for E/M level selection.
- Work RVU: 2.60.
- Non-facility PE RVU: 2.47; facility PE RVU: 0.66.
- Malpractice RVU: 0.24.
CPT 99204 2026 RVU components
Values from the imported 2026 CMS RVU data set used by RVUinUSA. Payment estimates require setting, locality, and conversion factor assumptions.
RVU values describe financial and productivity inputs after code selection. They are not coding advice.
How this connects to RVU payment
GPCI is applied component by component. A locality comparison is only meaningful when the CPT code, setting, and participant status stay fixed.
- Code input
- CPT/HCPCS
- Setting input
- Facility or office
- Output
- Adjusted total RVU
National total RVU and payment estimate
At national GPCI values, 99204 has a non-facility total RVU of 5.31 and a facility total RVU of 3.50. Using the 2026 non-QPP conversion factor of $33.4009, that produces an estimated national non-facility Medicare payment of about $177.36 and an estimated national facility payment of about $116.90. QPP/APM status changes the final multiplier, not the CPT RVU components. A professional estimate should always preserve the code, setting, locality, data year, and participant status beside the dollar result.
- National non-facility total RVU: 5.31; non-QPP estimate about $177.36.
- National facility total RVU: 3.50; non-QPP estimate about $116.90.
- The setting difference comes from practice expense RVU, not work RVU.
National 99204 payment model
Use 2.47 PE RVU for non-facility estimates and 0.66 PE RVU for facility estimates before locality GPCI adjustment.
Compare 99204 with adjacent new patient codes
99204 is often compared with 99203 and 99205 because they are adjacent new patient office or outpatient levels. That comparison is useful for RVU and payment context, but it should not be used to choose a code. In the same national non-facility assumptions, 99203 totals 3.52 RVU, 99204 totals 5.31 RVU, and 99205 totals 7.09 RVU. The correct E/M level depends on the applicable rules for the encounter. RVUinUSA's role is to show the payment and productivity impact once the coding basis is established.
- 99203: 1.60 work RVU and 3.52 national non-facility total RVU.
- 99204: 2.60 work RVU and 5.31 national non-facility total RVU.
- 99205: 3.50 work RVU and 7.09 national non-facility total RVU.
New patient E/M comparison
National non-facility comparison using imported 2026 RVU components before locality adjustment.
The table is an RVU comparison. It does not determine the correct E/M level for a specific patient encounter.
Do not compare 99204 and 99214 as the same visit type
Searchers often compare 99204 and 99214 because both are common office E/M codes, but they answer different visit-context questions. 99204 is a new patient visit code, while 99214 is an established patient visit code. In the 2026 RVU data, 99204 carries 2.60 work RVU and 5.31 national non-facility total RVU, while 99214 carries 1.92 work RVU and 4.06 national non-facility total RVU. That does not mean one code is a substitute for the other. The patient's status, visit type, documentation, payer rules, and E/M requirements control code selection before RVU impact is reviewed.
- 99204 is a new patient E/M code; 99214 is an established patient E/M code.
- Compare RVU values only after the correct visit family is known.
- Use RVU output to interpret economics, not to convert one visit type into another.
Use 99204 carefully in productivity and contract review
For physician compensation, 99204 contributes 2.60 work RVU when the employment agreement credits the service. The compensation impact depends on legitimate new patient volume, the contract's dollars-per-wRVU rate, schedule year, threshold, modifier rules, exclusions, and whether the plan counts the same CMS RVU schedule used for the estimate. New patient access can materially affect annual productivity, but a contract review should not assume that Medicare payment equals physician compensation. Medicare payment uses total RVU, GPCI, and conversion factor assumptions; employment compensation usually uses credited work RVU and written contract rules.
- Use 2.60 wRVU for productivity modeling only when the contract credits 99204.
- Separate Medicare payment estimates from employment compensation calculations.
- Review whether the contract freezes RVU values to a specific CMS schedule year.
Run 99204 through RVUinUSA tools
The practical workflow is to open the 99204 CPT page, confirm the imported 2026 RVU components, run the RVU calculator with the correct setting and GPCI locality, and then compare adjacent new patient codes only with the same assumptions. If the question is compensation, use the salary estimator or contract analyzer after the code mix and credited wRVU rules are known. If the question is payment, keep the conversion factor and locality visible with the result.
- Use /cpt/99204 for code-level RVU components.
- Use the RVU calculator for same-assumption payment estimates.
- Use contract tools only after the written productivity rules are clear.
99204 RVU workflow
Move from code-level RVU lookup to payment, locality, and contract interpretation.