HCPCS 99204
Evaluation and management service (ClaimLight category; the code descriptor is not shown)
Evaluation and management Work RVU per service 2.60 (2021 fee schedule)
Trend
Medicare payment on the code
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.
Billers
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.
| observed | calculated | calculated | calculated | calculated | calculated | reported | |
|---|---|---|---|---|---|---|---|
| 2024 | 232,660 | $1,277,271,515 | -0% | 11,508,274 | 32 | 145 | 2.60 |
| 2023 | 227,068 | $1,280,920,740 | -0% | 11,396,351 | 32 | 147 | 2.60 |
| 2022 | 221,779 | $1,282,105,303 | -1% | 11,192,583 | 33 | 148 | 2.60 |
| 2021 | 214,681 | $1,290,527,754 | +47% | 10,853,501 | 33 | 147 | 2.60 |
| 2020 | 165,869 | $879,474,824 | first year in data | 7,780,468 | 31 | 135 | 2.43 |
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.
By state
| observed | calculated | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|---|
| Florida | 17,850 | $131,799,117 | 1,090,381 | 38 | 187 | |
| California | 17,535 | $127,598,697 | 993,612 | 35 | 168 | |
| New York | 13,662 | $93,514,639 | 664,026 | 32 | 140 | |
| Texas | 15,115 | $90,512,406 | 778,505 | 34 | 147 | |
| Pennsylvania | 9,718 | $52,085,233 | 434,429 | 30 | 129 | |
| Illinois | 8,445 | $49,477,671 | 408,982 | 32 | 141 | |
| New Jersey | 6,603 | $45,102,728 | 333,526 | 35 | 142 | |
| North Carolina | 8,023 | $43,540,498 | 390,056 | 32 | 142 | |
| Virginia | 6,506 | $40,588,933 | 343,073 | 35 | 146 | |
| Maryland | 4,991 | $38,843,100 | 298,147 | 38 | 178 | |
| Ohio | 7,834 | $37,826,149 | 341,400 | 30 | 121 | |
| Georgia | 6,785 | $37,524,976 | 326,548 | 33 | 134 | |
| Arizona | 5,452 | $37,359,617 | 329,554 | 36 | 191 | |
| Massachusetts | 5,502 | $32,872,674 | 265,053 | 33 | 135 | |
| Tennessee | 5,263 | $30,116,216 | 277,551 | 35 | 150 |
Not listed: 33 billers with an armed-forces or unknown state code (AA, AE, AP, XX, ZZ); they are in the national totals.
Not listed: 1 state with fewer than 11 billers (small cells).
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2021.
Top metro areas
| observed | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|
| New York-Newark-Jersey City, NY-NJ | 14,231 | $106,584,228 | 737,556 | 34 | |
| Los Angeles-Long Beach-Anaheim, CA | 6,157 | $44,561,036 | 338,723 | 34 | |
| Chicago-Naperville-Elgin, IL-IN | 6,666 | $39,158,158 | 319,581 | 31 | |
| Philadelphia-Camden-Wilmington, PA-NJ-DE-MD | 5,214 | $32,279,701 | 255,007 | 32 | |
| Miami-Fort Lauderdale-West Palm Beach, FL | 4,377 | $31,389,038 | 247,478 | 36 | |
| Washington-Arlington-Alexandria, DC-VA-MD-WV | 4,155 | $31,093,027 | 234,743 | 37 | |
| Dallas-Fort Worth-Arlington, TX | 4,132 | $25,896,705 | 217,764 | 35 | |
| Phoenix-Mesa-Chandler, AZ | 3,718 | $25,409,296 | 221,274 | 35 | |
| Boston-Cambridge-Newton, MA-NH | 4,002 | $23,235,177 | 185,872 | 31 | |
| Houston-Pasadena-The Woodlands, TX | 3,768 | $20,689,246 | 172,682 | 31 | |
| Atlanta-Sandy Springs-Roswell, GA | 3,627 | $19,402,432 | 163,963 | 32 | |
| Baltimore-Columbia-Towson, MD | 2,572 | $18,617,245 | 143,667 | 36 | |
| Tampa-St. Petersburg-Clearwater, FL | 2,679 | $15,987,356 | 135,203 | 34 | |
| Detroit-Warren-Dearborn, MI | 2,865 | $15,030,285 | 125,538 | 31 | |
| San Francisco-Oakland-Fremont, CA | 2,055 | $14,622,873 | 107,890 | 33 |
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 100 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2021.
Specialties billing 99204 nationally
Ophthalmology accounts for 8% of payment for 99204 nationally in 2021, across 72 specialties on claims.
| observed | calculated | calculated | calculated | calculated | calculated | |
|---|---|---|---|---|---|---|
| Ophthalmology | 9,321 | 4.3% | $104,118,716 | 8.1% | 891,263 | 96 |
| Orthopedic Surgery | 13,176 | 6.1% | $96,473,822 | 7.5% | 788,422 | 60 |
| Cardiology | 12,766 | 5.9% | $91,364,323 | 7.1% | 751,028 | 59 |
| Urology | 7,337 | 3.4% | $72,647,398 | 5.6% | 600,623 | 82 |
| Gastroenterology | 9,403 | 4.4% | $66,829,323 | 5.2% | 539,084 | 57 |
| Nurse Practitioner | 18,598 | 8.7% | $66,697,817 | 5.2% | 655,471 | 35 |
| Internal Medicine | 15,377 | 7.2% | $61,710,420 | 4.8% | 533,244 | 35 |
| Otolaryngology | 6,445 | 3.0% | $58,401,146 | 4.5% | 477,681 | 74 |
| Physician Assistant | 14,633 | 6.8% | $55,402,351 | 4.3% | 530,853 | 36 |
| Neurology | 6,779 | 3.2% | $54,721,440 | 4.2% | 443,077 | 65 |
| Family Practice | 14,533 | 6.8% | $51,358,869 | 4.0% | 453,871 | 31 |
| General Surgery | 8,651 | 4.0% | $40,703,936 | 3.2% | 334,928 | 39 |
| Pulmonary Disease | 5,591 | 2.6% | $37,148,643 | 2.9% | 298,657 | 53 |
| Physical Medicine and Rehabilitation | 3,472 | 1.6% | $29,506,691 | 2.3% | 234,972 | 68 |
| Dermatology | 5,536 | 2.6% | $29,022,978 | 2.2% | 246,538 | 45 |
Not listed: 5 specialties with fewer than 11 billers (small cells).
Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2021.
Top billers of 99204 nationally
Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.
Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations