CPT 99404
Global XXXPrev med cnsl indiv apprx 60
CPT 99404 Billing & Documentation Guide
CPT code 99404 (Prev med cnsl indiv apprx 60) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.95, a non-facility practice expense RVU of 1.32, and a malpractice RVU of 0.12, a total non-facility RVU of 3.39 and facility RVU of 2.49. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $115.91, though rates vary from $105.07 to $146.86 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99404, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99404 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Non-covered service
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 99404 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99404
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.95 | 1.95 |
| Practice Expense RVU | 1.32 | 0.42 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 3.39 | 2.49 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99404
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $121.81 | $86.24 | $116.71 - $138.02 | 29 |
| Florida | $117.17 | $87.01 | $113.31 - $121.17 | 3 |
| Georgia | $112.09 | $83.41 | $109.24 - $114.94 | 2 |
| Illinois | $115.62 | $86.57 | $111.65 - $119.1 | 4 |
| Michigan | $112.18 | $83.95 | $109.91 - $114.44 | 2 |
| North Carolina | $108.83 | $80.78 | $108.83 - $108.83 | 1 |
| New York | $122.85 | $89.32 | $109.83 - $129.17 | 5 |
| Ohio | $109.43 | $81.98 | $109.43 - $109.43 | 1 |
| Pennsylvania | $113.19 | $83.75 | $109.39 - $116.98 | 2 |
| Texas | $112.62 | $83.02 | $108.98 - $115.46 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99404
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99404 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99404
What does CPT code 99404 mean? +
CPT code 99404 represents: Prev med cnsl indiv apprx 60. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99404? +
The 2026 Medicare national average non-facility payment for CPT 99404 is $115.91. Rates range from $105.07 to $146.86 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99404? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99404? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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