99204
Office/outpatient visit, new patient, mod-high complexity
Office/outpatient visit, new patient, mod-high complexity is the #65 most-billed Medicaid procedure code, with $2.98B in payments across 32.4M claims from 2018–2024. The national median cost per claim is $84.03.
Total Paid
$2.98B
0.27% of all spending
Total Claims
32.4M
Providers
43K
Avg Cost/Claim
$92
National Cost Distribution
How much do providers bill per claim for 99204? Based on 41K providers billing this code nationally.
Median
$84.03
Average
$88.92
Std Dev
$47.71
Max
$1,373.22
Percentile Distribution (Cost per Claim)
50% of providers bill between $63.00 and $111.85 per claim for this code.
90% bill between $36.50 and $142.89.
Top 1% bill above $227.04.
About This Procedure
HCPCS code 99204 (Office/outpatient visit, new patient, mod-high complexity) was billed by 43K providers across 32.4M claims, totaling $2.98B in Medicaid payments from 2018–2024. This code was used for 30.2M unique beneficiaries.
Risk Assessment
Billing Statistics
Median Cost/Claim
$84.03
Providers Billing
41K
National Spending
$2.98B
Avg/Median Ratio
1.06×
Normal distribution
Top Providers Billing This Code
Ranked by total Medicaid payments for 99204
| # | Provider | Total Paid |
|---|---|---|
| 1 | City Medical Of Upper East Side Pllc New York, NY · Clinic/Center Urgent Care | $29.1M |
| 2 | Fast Pace Medical Clinic Pllc Spring Hill, TN · Family Medicine | $16.8M |
| 3 | Montefiore Medical Center Bronx, NY · Anesthesiology | $15.8M |
| 4 | North Shore-lij Medical Pc Great Neck, NY · Urology | $15.3M |
| 5 | Nextcare Arizona Llc Tempe, AZ · Clinic/Center, Urgent Care | $14.6M |
| 6 | Mnr Industries Llc Bel Air, MD · Clinic/Center Urgent Care | $10.4M |
| 7 | Boston Medical Center Corporation Boston, MA · General Acute Care Hospital | $10.0M |
| 8 | Vanderbilt University Medical Center Nashville, TN · Transplant Surgery | $9.2M |
| 9 | Lsu Health Sciences Center Shreveport Faculty Group Practice Shreveport, LA · Oral & Maxillofacial Surgery | $9.0M |
| 10 | New York University Boynton Beach, FL · Anesthesiology | $8.5M |
| 11 | Planned Parenthood/orange And San Bernardino Counties, Inc. Orange, CA · Clinic/Center, Ambulatory Family Planning Facility | $8.5M |
| 12 | West Virginia University Medical Corporation Morgantown, WV · Anesthesiology | $8.4M |
| 13 | 1134349954 | $8.3M |
| 14 | Seattle Children's Hospital Seattle, WA · Prosthetic/Orthotic Supplier | $8.1M |
| 15 | 1942623319 | $7.9M |
| 16 | 1225331903 | $7.7M |
| 17 | 1932586476 | $6.8M |
| 18 | 1467715490 | $6.7M |
| 19 | University Physicians Incorporated Aurora, CO · Anesthesiology | $6.7M |
| 20 | Community Care Health Network Llc Nashville, TN · Nurse Practitioner | $6.6M |
Showing top 20 of 43K providers billing this code