Code Reality Check
99204 reimbursement rate: Office visit, new patient, 45-59 min
Office visit, new patient, 45-59 min (CPT 99204) pays a median $332.43 in Wisconsin and $121.78 in Kentucky, against a Medicare anchor of $166.93. 51 of 51 states clear the publication floor.
spread 2.7x top to bottom
Medicare anchor $166.93
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| Wisconsin | $332.43 | 1.99x | $172–$464 · P90 $534 | 40,255 | Benchmark |
| Minnesota | $215.95 | 1.29x | $169–$295 · P90 $409 | 8,782 | Benchmark |
| Colorado | $212.90 | 1.28x | $164–$347 · P90 $434 | 9,566 | Benchmark |
| New Hampshire | $201.34 | 1.21x | $201–$255 · P90 $354 | 7,607 | Benchmark |
| Massachusetts | $201.34 | 1.21x | $155–$255 · P90 $381 | 7,655 | Benchmark |
| Maine | $195.37 | 1.17x | $154–$254 · P90 $319 | 10,453 | Benchmark |
| Iowa | $185.00 | 1.11x | $151–$212 · P90 $322 | 1,742 | Benchmark |
| South Dakota | $185.00 | 1.11x | $144–$245 · P90 $343 | 338 | Benchmark |
| Hawaii | $185.00 | 1.11x | $140–$213 · P90 $309 | 1,074 | Benchmark |
| South Carolina | $185.00 | 1.11x | $136–$213 · P90 $270 | 7,048 | Benchmark |
| District of Columbia | $183.60 | 1.10x | $148–$293 · P90 $314 | 1,753 | Benchmark |
| North Dakota | $183.50 | 1.10x | $135–$213 · P90 $284 | 418 | Benchmark |
| Nebraska | $181.68 | 1.09x | $142–$234 · P90 $315 | 661 | Benchmark |
| Oregon | $180.00 | 1.08x | $135–$220 · P90 $353 | 2,105 | Benchmark |
| New Mexico | $180.00 | 1.08x | $135–$227 · P90 $335 | 1,149 | Benchmark |
| Louisiana | $180.00 | 1.08x | $135–$213 · P90 $335 | 1,657 | Benchmark |
| Utah | $180.00 | 1.08x | $135–$202 · P90 $330 | 1,301 | Benchmark |
| Washington | $180.00 | 1.08x | $135–$215 · P90 $349 | 4,168 | Benchmark |
| Oklahoma | $179.99 | 1.08x | $141–$213 · P90 $307 | 1,411 | Benchmark |
| New Jersey | $179.88 | 1.08x | $128–$246 · P90 $360 | 19,129 | Benchmark |
| Montana | $176.06 | 1.05x | $135–$222 · P90 $377 | 519 | Benchmark |
| Delaware | $175.84 | 1.05x | $147–$212 · P90 $292 | 1,114 | Benchmark |
| Maryland | $175.68 | 1.05x | $141–$213 · P90 $305 | 5,495 | Benchmark |
| Arizona | $174.65 | 1.05x | $135–$213 · P90 $337 | 4,230 | Benchmark |
| Idaho | $173.75 | 1.04x | $135–$213 · P90 $319 | 664 | Benchmark |
| Connecticut | $173.41 | 1.04x | $115–$256 · P90 $430 | 4,356 | Benchmark |
| Wyoming | $172.83 | 1.04x | $135–$200 · P90 $293 | 626 | Benchmark |
| Mississippi | $170.74 | 1.02x | $136–$213 · P90 $335 | 771 | Benchmark |
| California | $170.60 | 1.02x | $136–$313 · P90 $589 | 142,132 | Benchmark |
| Florida | $170.12 | 1.02x | $134–$213 · P90 $302 | 18,575 | Benchmark |
| Georgia | $170.12 | 1.02x | $149–$270 · P90 $327 | 82,528 | Benchmark |
| Nevada | $169.94 | 1.02x | $135–$213 · P90 $333 | 1,827 | Benchmark |
| Texas | $169.40 | 1.01x | $138–$213 · P90 $317 | 31,404 | Benchmark |
| Rhode Island | $169.16 | 1.01x | $155–$222 · P90 $243 | 4,899 | Benchmark |
| Pennsylvania | $168.67 | 1.01x | $145–$188 · P90 $251 | 34,313 | Benchmark |
| Michigan | $168.66 | 1.01x | $136–$207 · P90 $329 | 7,094 | Benchmark |
| Illinois | $168.66 | 1.01x | $141–$203 · P90 $356 | 14,513 | Benchmark |
| Indiana | $168.66 | 1.01x | $149–$182 · P90 $218 | 46,989 | Benchmark |
| Alaska | $168.64 | 1.01x | $129–$218 · P90 $325 | 380 | Benchmark |
| Arkansas | $168.22 | 1.01x | $136–$213 · P90 $306 | 1,288 | Benchmark |
| Alabama | $167.43 | 1.00x | $135–$197 · P90 $284 | 2,725 | Benchmark |
| Tennessee | $166.61 | 1.00x | $135–$213 · P90 $273 | 7,122 | Benchmark |
| Virginia | $160.51 | 0.96x | $147–$213 · P90 $257 | 27,315 | Benchmark |
| Kansas | $151.80 | 0.91x | $129–$201 · P90 $306 | 1,848 | Benchmark |
| Missouri | $151.40 | 0.91x | $129–$187 · P90 $272 | 54,051 | Benchmark |
| North Carolina | $142.79 | 0.86x | $129–$213 · P90 $249 | 99,353 | Benchmark |
| Ohio | $141.00 | 0.84x | $111–$225 · P90 $321 | 98,146 | Benchmark |
| West Virginia | $141.00 | 0.84x | $113–$179 · P90 $234 | 2,191 | Benchmark |
| New York | $139.50 | 0.84x | P75 $293 · P90 $430 | 185,568 | Benchmark |
| Vermont | $126.69 | 0.76x | P75 $201 · P90 $255 | 1,429 | Benchmark |
| Kentucky | $121.78 | 0.73x | $95–$167 · P90 $220 | 24,499 | Benchmark |
Payer-blind local peer percentiles per state, full verified distribution. Publication floor: 11 verified rate points and a non-degenerate spread; the P25–P75 band unlocks at 25 points, P90 at 100 (a smaller cell's P90 is one contract, not a statistic).
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
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Cite this page
Source: Reddenda Code Reality Check, CPT 99204. Reddenda. https://reddenda.health/code/99204/
Derivation federally mandated TiC MRFs, verified to provider identity1,036,236 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0