CPT 99202: New Patient Office Visit, Straightforward MDM
Medicare pays $78 and commercial payers pay $101 on average nationally for this procedure.
CPT code 99202 describes an evaluation and management office or other outpatient visit for a new patient involving straightforward medical decision making or 15 or more minutes of total provider time on a single date; the service typically represents an office outpatient visit provided in a clinic or physician office setting for problem-focused evaluation and management of a new patient.
For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.
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National Reimbursement Benchmarks
Medicare’s mean allowed amount for CPT 99202 sits at $77.7, closely trailing BUCA’s average commercial mean of $101.1 by $23.4. This positions Medicare near the lower-middle of the national spectrum while BUCA aligns with mid-range commercial reimbursement levels.
Dispersion measured by the interquartile range (P75 minus P25) varies notably: Blue Cross Blue Shield displays one of the tightest IQRs at $53.1 (P75 $133.2 minus P25 $79.1), while Aetna’s IQR is $44.9 and Cigna’s is $50.6. UnitedHealth Group shows a wider spread of $57.4, and BUCA’s IQR is $53.6. Overall, UnitedHealth Group has the widest IQR, indicating greater variability, while Blue Cross Blue Shield is among the tightest payers in the middle 50%.