99204 Insurance Policy Changes

CPT 99204, in plain terms, covers A doctor's visit for a new patient requiring moderate complexity and about 45 minutes of the provider's time. CPT 99204 is referenced in 50 tracked payer policy changes from CareSource, NC Medicaid - NCDHHS, and 22 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99204 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 99204 on AAPC