What Is CPT Code 99202 for New Patient Visits?

Current Procedural Terminology (CPT) codes standardize medical service descriptions for billing and record-keeping. These codes enable consistent communication between providers, patients, and insurers regarding the care delivered. CPT code 99202 is used for a specific patient visit type, enabling accurate classification and reimbursement.

What CPT 99202 Represents

CPT code 99202 is an Evaluation and Management (E/M) code, which encompasses a healthcare provider’s assessment, diagnosis, and ongoing management of a patient’s health concerns. This particular code is exclusively designated for new patient office or other outpatient visits. It signifies a “Level 2” service within the new patient E/M code set, indicating a moderate degree of complexity for such an initial encounter.

In this context, a “new patient” is defined as an individual who has not received any professional services from the physician or other qualified healthcare professional, or from another professional of the exact same specialty and subspecialty within the same group practice, over the preceding three years. This three-year rule ensures that the patient’s initial visit to a specific provider or group is appropriately categorized.

Criteria for Billing CPT 99202

For office and other outpatient E/M services like CPT 99202, healthcare providers determine the appropriate code based on either the medical decision making (MDM) involved or the total time spent on the date of the encounter. Providers only need to satisfy the requirements for one of these two criteria to bill for the service.

Regarding medical decision making, CPT 99202 requires a “straightforward” level of MDM. Straightforward medical decision making involves minimal complexity concerning the problems addressed, the amount and complexity of data to be reviewed and analyzed, and the risk of complications or morbidity/mortality associated with patient management. This typically means addressing one self-limited or minor problem, with minimal or no data review, and minimal risk. An example of minimal risk might involve decisions about prescription drug management for a simple condition.

Alternatively, providers can select CPT 99202 based on the total time spent on the date of the encounter. This specific code is associated with a time range of 15 to 29 minutes. “Total time” includes both face-to-face time with the patient and non-face-to-face activities performed by the physician or other qualified healthcare professional on the day of the encounter, such as:

• Preparing to see the patient
• Reviewing previously obtained history
• Performing an examination
• Counseling the patient
• Ordering tests or medications
• Communicating with other healthcare professionals
• Documenting clinical information

Time spent by clinical staff, travel, or general teaching not specific to the patient’s care is not included in this total time calculation.

Typical Scenarios for a 99202 Visit

A new patient visit billed under CPT 99202 typically involves a medically appropriate history and/or physical examination. The interaction often includes a focused history, a limited physical assessment, and a straightforward discussion about a single, minor health issue.

Common situations that might qualify for a CPT 99202 visit include a new patient presenting with uncomplicated symptoms such as a common cold or flu, which do not necessitate extensive diagnostic workup. Another scenario could be a new patient seeking evaluation for a minor, uncomplicated injury, such as a small cut or a mild sprain that does not require complex imaging or referrals. New patients might also use this code for initial consultations regarding mild acne, a minor skin rash, or for basic wellness advice and health screenings that are straightforward in nature. Furthermore, a low-complexity initial consultation for stress management or a visit for routine health concerns like mild fatigue or minor skin irritation would also fit the criteria.