CPT 00104
Status J Payable, but priced under a separate anesthesia formula (base + time units × conversion factor), not the standard PFS RVU formula. Ask for a locality to see the anesthesia conversion factor. Full definition →No national payment amount
Anesthesia code: paid via base + time units × a separate anesthesia conversion factor, not the standard PFS RVU formula. Supply a locality (and time_minutes for a specific amount) to compute it.
See your local estimate for a standard 30-minute case.
Payable, but priced under a separate anesthesia formula (base + time units × conversion factor), not the standard PFS RVU formula. Ask for a locality to see the anesthesia conversion factor.
Common questions
Why is there no payment amount for 00104?
Its status indicator is J (anesthesia). Payable, but priced under a separate anesthesia formula (base + time units × conversion factor), not the standard PFS RVU formula. Ask for a locality to see the anesthesia conversion factor. The blank is deliberate: the amount is unknown or paid another way, not zero.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October). Each release is versioned here, so past quarters stay lookupable — see what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill?
What is a 00104 visit in patient-friendly terms?
CPT 00104 is a billing code clinicians use to identify a specific service or procedure on a claim or explanation of benefits (EOB). We don't have a plain-language description on file for this exact code yet — ask your provider's billing office what service it represents, or bring it up at your next visit.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A value of blank means CMS publishes no national number for that part — which is not the same as zero.
Rate history by release
National non-facility amount for 00104 across quarterly releases.
Billing together (NCCI edits)
NCCI Q3 2026Per CMS's National Correct Coding Initiative. Hover a code for when it's used.
Never billable with 00104 on the same date of service
Billable with 00104 only with modifier 59, XE, XS, XP, or XU