Initial Consultation Appointment

Neurology Billed together on one claim

Consultation only

99204

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Price for scenario

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Fee schedule

2026 Medicare PFS · RVU26D

Effective October 1, 2026 · CF $33.4009

Locality

San Jose Sunnyvale Santa Clara (Santa Clara Cnty), CA (01112-09)

Setting · provider

Office (non-facility) rates · Physician

Payer

Traditional Medicare

Priced as of

November 13, 2026

Medicare allowed

$218.54

Total the claim is paid on

Medicare pays

$171.33

80%, less 2% sequestration

Patient owes

$43.71

20% coinsurance, once the Part B deductible is met

Billing rules changed it by

—

from $218.54 at full fee schedule

Nothing to resolve before billing: no prior authorization, documentation or coding flags for these codes.

Highest-paid first, the order Medicare ranks multiple procedures

Code	Description	Units	Fee schedule	× Units	Adjustments	Allowed
99204	Office o/p new mod 45 min	1	$218.54	$218.54	—	$218.54
Total				$218.54	—	$218.54

Before the Part B deductible

Until the patient meets the annual Part B deductible, they pay the full allowed amount instead of 20% coinsurance.

How each fee is calculated (Work RVU × GPCI + PE RVU × GPCI + MP RVU × GPCI) × conversion factor ▸

Code	Work	Practice expense	Malpractice	Adjusted RVU	× CF	Fee	Global	Multiple procedure	Bilateral (50)	Assistant	Co-surgeon (62)
99204	2.6 × 1.11	2.47 × 1.442 non-facility	0.24 × 0.397	6.5430	33.4009	$218.54	No global period	No reduction	No bilateral adjustment	Needs documentation	Not permitted

GPCIs for San Jose Sunnyvale Santa Clara (Santa Clara Cnty), CA (01112-09) in RVU26D. Imaging fees are capped at the OPPS amount when that's lower.