Rate benchmarks · Cigna · CPT 99204

What does Cigna pay for 99204?

Office o/p new mod 45 min

The median Cigna office rate for CPT 99204 is $153.17 — about 92% of the Medicare allowed amount ($166.14). These benchmarks come from Cigna's federally required price-transparency disclosures, normalized to clean, comparable, per-procedure rates.

Last verified July 2026 · 44,317 contracting groups nationally

How to read these numbers

A negotiated rate is the contract-specific allowed amount Cigna has agreed to pay an in-network practice for a service — the number that actually lands on your remittance, not the billed charge. Since July 2022, the federal Transparency in Coverage rule has required every commercial insurer to publish every negotiated rate, for every provider group, in public machine-readable files (MRFs). The figures on this page are aggregated directly from Cigna's own filings for CPT 99204.

The median ($153.17 in the office setting) is the middle contract: half of Cigna's contracting groups are paid more, half less. The 25th–75th percentile range ($56.58–$202.87) is where the middle half of contracts sit — the practical negotiating band. In a renegotiation, where your rate falls in this distribution is the argument: below the 25th percentile means most comparable groups signed better terms for the identical service, and the dollars between your rate and the median are recoverable on every single visit.

% of Medicare converts each commercial rate to a multiple of the Medicare Physician Fee Schedule allowed amount (CY 2026). Payer contracts are very often written this way — “105% of the current Medicare fee schedule” — because it prices thousands of codes with one number and updates automatically each year. Knowing that Cigna's median for 99204 is roughly 92% of Medicare lets you compare offers across codes, payers, and years on one common scale.

Office vs. facility: which row applies to you?

The professional rate for the same CPT code differs by site of service. The office row ($153.17 median) applies when the visit happens in a practice-owned office and the practice absorbs the overhead. The facility row ($156.1 median) applies when the service is delivered in a hospital outpatient department or ambulatory surgery center: the facility bills its own separate fee, so the professional payment is lower. An independent practice comparing its 99204 contract should look at the office row; a hospital-employed or hospital-based group should use the facility row.

Methodology & data freshness

• Source. Cigna's public Transparency in Coverage machine-readable files — the insurer's own federally mandated disclosure of every in-network negotiated rate. No claims data, surveys, or estimates.
• Sample. Benchmarks for 99204 span 44,317 contracting groups nationally, collapsed to one representative professional rate per group so a large group with many clinicians doesn't outweigh a small one.
• Cleaning. Payment-reducing modifier lines (assistant-surgeon, reduced-service, and similar) are excluded, and rates implausibly far from the Medicare benchmark are dropped before percentiles are computed, so the median reflects real, payable base rates.
• Freshness. Insurers republish these files monthly; benchmarks are rebuilt on the same cadence and this page revalidates daily. Data refreshed July 2026. Medicare comparisons use the CY 2026 Medicare Physician Fee Schedule.

Cigna 99204 rate FAQ

Is $153.17 a good rate for CPT 99204?

$153.17 is the median — the middle contract — across 31,956 Cigna contracting groups nationally. If your allowed amount for 99204 is below the 25th percentile ($56.58), most comparable groups negotiated more than you did, and that gap is usually the strongest line in a renegotiation request. At or above the 75th percentile ($202.87), you are already ahead of most of the market on this code. Compare your own rate free →

Why does Cigna pay different practices different amounts for 99204?

Commercial rates are set contract by contract, not from a single public fee schedule. Two practices on the same street can be paid very differently for 99204 depending on group size, specialty mix, negotiating leverage, and how long it has been since anyone re-opened the agreement. That is why the middle half of Cigna contracts alone spans $56.58 to $202.87 — a $146 spread on a single visit.

How do I find my practice's contracted Cigna rate for 99204?

Check the fee schedule exhibit attached to your Cigna agreement, or pull the allowed amount (not the billed charge) from recent remittances for 99204. If neither is handy, EarnestMD resolves your providers inside Cigna's published rate files and shows your contracted rate next to these benchmarks — the first code comparison is free. Look up your rate →

Can I negotiate my Cigna rate for 99204?

Usually, yes. Most commercial agreements allow a renegotiation request or renew on an anniversary date, and payers do adjust rates for practices that arrive with data. Showing that your 99204 rate sits below the median of $153.17 across 31,956 contracting groups is a far stronger opening than asking for a flat percentage increase. Read the renegotiation guide →

Why are the office and facility rates for 99204 different?

The professional rate depends on site of service. When the visit happens in a practice-owned office, Cigna's median is $153.17; when it happens in a hospital outpatient department or ambulatory surgery center — where the facility bills its own separate fee — the professional payment drops to a median of $156.1, because the practice is no longer covering the overhead. Benchmark against the setting where you actually deliver the service.

How current is this Cigna rate data?

Cigna republishes its machine-readable rate files monthly under the federal Transparency in Coverage rule, and these benchmarks are rebuilt on the same cadence. This page was last verified July 2026, with Medicare comparisons drawn from the CY 2026 Medicare Physician Fee Schedule.

Source: Cigna Transparency in Coverage machine-readable files, refreshed monthly; last verified July 2026. Aggregate benchmarks over 44,317 contracting groups; no individual practice or contract is identified. EarnestMD is independent and not affiliated with any insurer. This page is informational and is not legal or payer-contracting advice.