What Is CPT Code 99202 on Your Medical Bill?
Demystify CPT Code 99202 on your medical bill. Understand this common new patient visit code and what it signifies for your healthcare costs.
Medical billing involves Current Procedural Terminology (CPT) codes, which are standardized numerical codes used by healthcare providers and insurers to describe medical, surgical, and diagnostic services. These codes ensure consistent communication and processing of claims. CPT Code 99202 is an example of such a code, specifically designated for certain types of medical services.
What is Code 99202
CPT Code 99202 identifies an Evaluation and Management (E/M) service for a new patient in an office or other outpatient setting. A “new patient” is defined as an individual who has not received professional services from the physician or another physician of the same specialty within the same group practice within the past three years. This distinction is important because service levels differ between new and established patients. The “2” in 99202 indicates a straightforward encounter for a new patient.
Components of a 99202 Visit
A new patient office visit billed under CPT Code 99202 typically involves key components: patient history, physical examination, and medical decision making (MDM). Alternatively, the total time spent by the physician or other qualified healthcare professional on the date of the encounter can determine the code level. For a 99202 visit, medical decision making is considered straightforward, or the total time spent typically ranges from 15 to 29 minutes. This time includes both face-to-face time with the patient and non-face-to-face time spent on the patient’s care on the same day.
How Providers Use Code 99202 for Billing
Healthcare providers utilize specific guidelines to accurately select the appropriate CPT code for billing. For office or other outpatient E/M services like 99202, the primary factors determining code selection are the complexity of medical decision making (MDM) or the total time spent on the date of the encounter. CPT Code 99202 specifically requires straightforward MDM. Straightforward MDM involves a minimal number of diagnoses or treatment options, minimal amount and/or complexity of data to be reviewed and analyzed, and a minimal risk of complications and/or morbidity or mortality of patient management. When time is used as the basis for code selection, the provider must document 15 to 29 minutes of total time spent on the patient’s care during the encounter day.
Understanding Code 99202 on Your Medical Bill
When you receive a medical bill or an Explanation of Benefits (EOB), seeing CPT Code 99202 indicates a charge for a new patient office visit. This code signifies that you received an initial consultation or service as a new patient. The amount billed for a 99202 service can vary significantly depending on the healthcare provider’s fees, geographic location, and contractual agreements with insurance plans. Your insurance coverage will largely determine your out-of-pocket expenses, which may include deductibles, co-payments, or co-insurance amounts. If this code appears, it represents a standard charge for a new patient visit that involved straightforward medical decision-making or a specific duration of time.