99202
Office or outpatient evaluation and management visit for a new patient involving straightforward medical decision making or 15–29 minutes of total time.
Code Description
CPT code 99202 is used for an office or other outpatient evaluation and management visit involving a new patient. The service must include a medically appropriate history and/or examination.
The code may be selected based on straightforward medical decision making or 15–29 minutes of total physician or qualified healthcare professional time on the date of the encounter.
A patient is generally considered new when they have not received professional services from the physician, another qualified healthcare professional, or another clinician of the same specialty and subspecialty in the same group practice during the previous three years.
When to Use 99202
Use CPT code 99202 when all of the following apply:
The patient qualifies as a new patient
The service takes place in an office or other outpatient setting
A medically appropriate history and/or examination is performed
The encounter involves straightforward medical decision making
When selecting the code based on time, the physician or qualified healthcare professional must personally spend 15–29 minutes performing qualifying work on the date of the encounter.
Straightforward medical decision making commonly involves a minor or self-limited problem, minimal or no data review, and minimal risk from testing or treatment.
When NOT to Use CPT Code 99202
Do not report CPT code 99202 when:
The patient is an established patient rather than a new patient.
Medical decision making exceeds the straightforward level and supports a higher-level E/M service.
The total physician or qualified healthcare professional time exceeds the requirements for CPT code 99202.
The encounter occurs in a setting that requires a different category of E/M code.
Another CPT code more accurately describes the service provided.
Selecting the correct E/M code helps reduce claim denials and ensures appropriate reimbursement.
Documentation Requirements
Documentation should clearly support the level of service reported and include:
The patient’s reason for the visit
Relevant history and examination findings
The condition or problem evaluated
The assessment and treatment plan
The medical decision-making elements addressed
The patient’s new-patient status
Total qualifying time when the code is selected based on time
A specific history or examination level is not required. The extent of the history and examination should be medically appropriate for the patient’s condition.
When billing based on time, document the total time spent on qualifying activities performed on the date of the encounter. Total time may include reviewing records, examining the patient, counseling, ordering services, documenting the visit, and coordinating care.
Documentation Checklist
Before submitting CPT code 99202, confirm that the medical record includes:
✓ Patient qualifies as a new patient
✓ Chief complaint documented
✓ Medically appropriate history completed
✓ Examination documented when appropriate
✓ Assessment and treatment plan completed
✓ Straightforward medical decision making supported
✓ Appropriate ICD-10-CM diagnosis linked
✓ Total time documented when billing based on time
✓ Medical necessity clearly established
Examples
Example 1
A new patient visits a primary care physician for mild nasal congestion and a sore throat. The physician performs a medically appropriate history and examination, diagnoses a self-limited viral illness, and recommends supportive care. The straightforward medical decision making supports CPT code 99202.
Example 2
A new patient presents with a small, uncomplicated insect bite without infection or systemic symptoms. The clinician evaluates the area, recommends basic home care, and provides instructions about symptoms that would require follow-up. The encounter involves minimal risk and straightforward medical decision making.
Example 3
A physician spends 22 minutes reviewing a new patient’s information, evaluating a minor complaint, counseling the patient, and documenting the encounter. CPT code 99202 may be reported based on total time because the qualifying work falls within the 15–29-minute range.
Coding & Billing Tips
Verify the patient meets the definition of a new patient before reporting CPT code 99202.
Select the code using either medical decision making or total time—not both.
Link the most specific ICD-10-CM diagnosis available.
Document all qualifying physician or qualified healthcare professional time when billing by time.
Review payer-specific telehealth and modifier requirements when applicable.
Ensure documentation clearly supports medical necessity.
Verify that no higher-level E/M code more accurately reflects the complexity of the encounter.
Common Billing Mistakes
Using 99202 for an established patient
Do not report 99202 when the patient has received professional services from the same physician or another clinician of the same specialty and subspecialty within the same group during the previous three years.
Describing the visit as low complexity
CPT code 99202 requires straightforward medical decision making. Low medical decision making corresponds to CPT code 99203.
Reporting 99202 for fewer than 15 minutes
When selecting the code based on time, at least 15 minutes of qualifying time must be documented.
Using face-to-face time only
Total time may include qualifying face-to-face and non-face-to-face work personally performed on the date of the encounter.
Counting staff time
Time independently spent by clinical staff generally cannot be included in the physician or qualified healthcare professional’s total time.
Billing based on both MDM and time
The code may be selected using either medical decision making or total time. The documentation only needs to support the method used.
Failing to support straightforward MDM
The record should clearly identify the problem addressed, information reviewed, treatment plan, and level of patient-management risk.
Common ICD-10-CM Codes
J06.9 – Acute Upper Respiratory Infection, Unspecified
Commonly reported when a new patient is evaluated for symptoms of a viral upper respiratory infection, including cough, congestion, and sore throat.
J30.9 – Allergic Rhinitis, Unspecified
May support medical necessity when a new patient presents for evaluation and management of seasonal or perennial allergy symptoms.
L30.9 – Dermatitis, Unspecified
Often reported when evaluating a new patient with an uncomplicated rash, eczema, or other inflammatory skin condition.
M25.561 – Pain in Right Knee
Frequently used when a new patient is evaluated for uncomplicated right knee pain without a definitive diagnosis.
R05.9 – Cough, Unspecified
Appropriate when a patient's primary complaint is cough and a more specific diagnosis has not yet been established.
Applicable Modifiers
Modifier 25
Report Modifier 25 when a significant, separately identifiable evaluation and management service is performed on the same day as another procedure. Documentation must clearly support that the E/M service was above and beyond the usual preoperative and postoperative work associated with the procedure.
Modifier 95
Modifier 95 may be reported when the service is provided through a real-time interactive audio and video telehealth platform and the payer recognizes the modifier for eligible services.
Modifier GT
Some payers continue to require Modifier GT to identify services performed via telemedicine. Always verify payer-specific billing requirements before submitting the claim.
Related CPT Codes
99203
Office or other outpatient visit for a new patient, typically 30 minutes.
99204
Office or other outpatient visit for a new patient, typically 45 minutes.
99205
Office or other outpatient visit for a new patient, typically 60 minutes.
FAQ
Is CPT code 99202 for a new or established patient?
CPT code 99202 is used for a new patient. The patient generally must not have received professional services from the same physician or another clinician of the same specialty and subspecialty in the same group during the previous three years.
What is the time range for CPT code 99202?
The time range is 15–29 minutes when the code is selected based on total time.
What level of medical decision making is required for 99202?
CPT code 99202 requires straightforward medical decision making.
Does CPT 99202 require both straightforward MDM and 15–29 minutes?
No. The code may be selected based on either straightforward medical decision making or 15–29 minutes of total time.
Does CPT 99202 require a specific history and examination level?
No. The physician or qualified healthcare professional must perform a medically appropriate history and/or examination based on the patient’s condition.
Can CPT 99202 be used for telehealth?
It may be reportable for an eligible telehealth service when the payer’s current coverage, place-of-service, and modifier requirements are met. Verify the individual payer’s rules before submitting the claim.
Category
New Patient
Typical Time
MDM Level
15-29 Minutes
Straightforward
Description
Patient Type
CPT Code
99202
Office or outpatient E/M visit
Evaluation & Management
