PayPredict Today: 2026 Medicare PFS · RVU26D
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Initial Consultation Appointment

Neurology Billed together on one claim

Consultation only

99204

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Price for scenario

San Jose Inpatient MD $131.37
Facility · Traditional Medicare
San Jose Outpatient MD $218.54
Office · Traditional Medicare
+ Scenario

San Jose Inpatient MD

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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
Facility rates · Physician
Payer
Traditional Medicare
Priced as of
November 13, 2026
Medicare allowed
$131.37
Total the claim is paid on
Medicare pays
$103.00
80%, less 2% sequestration
Patient owes
$26.27
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
—
from $131.37 at full fee schedule

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

Claim lines

Highest-paid first, the order Medicare ranks multiple procedures
  1. 99204 $131.37
    Office o/p new mod 45 min
    Fee schedule $131.37
  2. Total allowed $131.37
    $131.37 fee schedule — billing rules

Notes · 1

  • 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 0.66 × 1.442
facility
 0.24 × 0.397 3.9330 33.4009 $131.37 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.