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99205

Office or other outpatient visit for the evaluation and management of a new patient, typically 60 minutes.

Code Description

CPT code 99205 is used for office or outpatient evaluation and management visits involving a new patient. This code typically represents a high level of medical decision making and approximately 60 minutes of total time spent on the date of the encounter.

Healthcare providers commonly report CPT 99205 for highly complex visits involving serious conditions, extensive evaluation, and high risk management decisions.

When to Use 99205

Use CPT 99205 for high-complexity new patient office visits involving significant medical decision making and comprehensive evaluation.

Common examples include:

  • severe or complex medical conditions

  • high risk treatment decisions

  • extensive record review

  • management of multiple serious conditions

  • advanced diagnostic evaluation

Documentation Requirements

Documentation should include:

  • medically appropriate history

  • medically appropriate examination

  • high level medical decision making

  • documented total encounter time when billing based on time

Common Billing Mistakes

Common billing mistakes for CPT 99205 include:

  • insufficient documentation for high complexity

  • incorrect patient classification

  • unsupported high level billing

  • inaccurate time documentation

Related CPT Codes

99202- Office or other outpatient visit for a new patient, typically 15 minutes.

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.

FAQ

Is CPT 99205 for new patients?

Yes. CPT 99205 is used only for new patient office or outpatient visits.

What is the typical time for CPT 99205?

The typical total time for CPT 99205 is 60 minutes.

What level of medical decision making is required?

CPT 99205 requires high level medical decision making.

Can CPT 99205 be billed based on time?

Yes. Providers may bill CPT 99205 using total encounter time when properly documented.

Patient Type

New Patient

Typical Time

MDM Level

60 Minutes

High