CPT Code 99202: E/M Office Visit, New Patient, Low Complexity
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making
CPT 99202 reports an E/M office visit for a new patient with straightforward medical decision making. In 2021+, time or MDM alone determines level.
When to use CPT 99202
Use when an E/M code is more appropriate than 92002/92004 (for example, ocular manifestations of systemic disease). New patient with straightforward MDM or 15 to 29 minutes total time on the date.
Documentation requirements
- MDM or total time
- Medically appropriate history and exam
- Clinical reasoning
Reimbursement
$70 to $100
National averages only. Rates vary by locality, payer, and fee schedule. Verify with your contracted payers.
Common modifiers
- -25
Common denial reasons for CPT 99202
- New vs established confusion
- Level mismatch with MDM or time
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