What is the top of the local market (P90) for CPT 99204 under Anthem Blue Cross (CA) for Atlanta-Sandy Springs-Roswell, GA providers?

The P90, the top of the local market and Reddenda's target rate, is $283.52.

How does Anthem Blue Cross (CA)'s rate for CPT 99204 compare to Medicare?

The Anthem Blue Cross (CA) local median of $185 is 104% of Medicare's national non-facility rate of $177.36 for CPT 99204.

Reddenda · Rate Intelligence · Atlanta-Sandy Springs-Roswell, GA

99204 under Anthem Blue Cross (CA), for Atlanta-Sandy Springs-Roswell, GA providers

Name: Anthem Blue Cross (CA) rates for CPT 99204 among Atlanta-Sandy Springs-Roswell, GA providers
Creator: Reddenda

Office visit, new patient, 45-59 min · Local peer median $185 · Medium confidence

$185 local peer median. Anthem Blue Cross (CA)'s published rate file lists a local peer median of $185 for CPT 99204 (Office visit, new patient, 45-59 min) among 359 indexed providers in Atlanta-Sandy Springs-Roswell, GA. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $283.52, 53% above the median. A provider billed below this median is being paid less than peers holding the identical Anthem Blue Cross (CA) contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 359 providers · 391 rate records

P10

$162.49

P25

$185

Median

$185

P75

$185

P90 (target)

$283.52

P10$162.49

P25$185

Median (P50)$185

P75$185

P90 target$283.52

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $120.45 – $484.63

The local peer median for CPT 99204 under Anthem Blue Cross (CA) for Atlanta-Sandy Springs-Roswell, GA providers is $185, drawn from 359 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate
The bottom of the local market (P10) is $162.49 and the top (P90) is $283.52; the median-to-P90 spread is $98.52.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate
The lowest published rate in this market is $120.45; the highest is $484.63.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate
This benchmark is drawn from 391 individual rate records that Anthem Blue Cross (CA) itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate
Medicare's national non-facility rate for CPT 99204 is $177.36, making the Anthem Blue Cross (CA) local median 104% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate
59.3% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

359 providers bill this code to this payer in this metro.

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These are the rates Anthem Blue Cross (CA) publishes for CPT 99204 (Office visit, new patient, 45-59 min) among Atlanta-Sandy Springs-Roswell, GA providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Anthem Blue Cross (CA)'s own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Anthem Blue Cross (CA) to publish this rate. Page generated 2026-08-23 23:08 UTC; the live index is queried in real time on every request.