Summary & Overview
CPT 99202: Office Visit for New Patients, Straightforward Decision Making
CPT code 99202 is a foundational billing code for office or outpatient visits involving the evaluation and management of new patients. It is widely used across the United States by primary care and general practice physicians to document encounters that require a medically appropriate history and/or examination, with straightforward medical decision making. The code is selected when the total time spent with the patient meets or exceeds 15 minutes, making it a key metric for both clinical documentation and reimbursement.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for services billed under CPT 99202. This publication provides an overview of the code’s clinical context, typical site of service, and its role in the evaluation and management of new patients. Readers will gain insight into relevant benchmarks, policy updates, and the broader implications for medical billing and compliance. The summary also highlights related codes and modifiers commonly used in conjunction with CPT 99202, offering a comprehensive perspective for healthcare professionals and administrators.
Understanding CPT 99202 is essential for accurate billing, compliance, and quality reporting in outpatient care settings. The code’s straightforward requirements make it a standard for documenting new patient visits, ensuring consistency across payers and clinical practices nationwide.
CPT Code Overview
CPT 99202 is used to report an office or other outpatient visit for the evaluation and management of a new patient. This code applies when the encounter requires a medically appropriate history and/or examination and straightforward medical decision making. When selecting this code based on total time, the visit must meet or exceed 15 minutes on the date of the encounter.
Service Type: Evaluation and Management – New Patient Office or Other Outpatient Visit
Typical Site of Service: Office or other outpatient settings, such as place of service 11.
Clinical & Coding Specifications
Clinical Context
A new adult patient presents to a physician's office for an initial evaluation. The visit includes a medically appropriate history and/or examination, and the medical decision making is straightforward. The encounter may address general health concerns, such as a routine check-up, or specific symptoms like cough, abdominal pain, or sore throat. The total time spent with the patient on the date of the encounter meets or exceeds 15 minutes. The service is provided in an office or other outpatient setting, and may be delivered in person or via synchronous telemedicine, depending on patient needs and provider capabilities.
Coding Specifications
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Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as another procedure or service. -
Modifier
95: Indicates that the service was rendered via a real-time interactive audio and video telecommunications system (synchronous telemedicine).
| Provider Taxonomy Code | Specialty Name |
|---|---|
207Q00000X | Family Medicine Physician |