CPT code 99202 is the lowest-level evaluation and management (E/M) code for a new patient office or outpatient visit. Since the AMA deleted CPT 99201 in 2021, CPT 99202 is the lowest-level code in the new-patient E/M code family (99202–99205). It is the counterpart to established-patient code 99212.
CPT 99202 and CPT 99212 share the same level of medical decision making (MDM), but they diverge in other ways: CPT 99202 requires five more minutes of total time when selected by time. It also pays more: the 2026 national non-facility rate under the Medicare Physician Fee Schedule is about $75, compared with about $59 for 99212.
That premium is why payers verify new-patient status. After recovery auditors identified improper payments for new patient visits, CMS directed its claims system to flag a second new patient visit billed by the same physician or group within three years. For 99202, the first coding question is not how complex the visit was, but whether the patient is new at all.
What is CPT code 99202 used for?
The AMA defines CPT 99202 as an office or other outpatient visit for the evaluation and management of a new patient. The visit must require a medically appropriate history or examination and straightforward MDM. When time is used for code selection, 15 minutes must be met or exceeded on the date of the encounter.
A physician or other qualified health care professional (QHP) has to personally perform the evaluation and management. Unlike the established-patient family, the new-patient family has no clinical-staff level below 99202: CPT 99211 cannot be billed for a new patient, and no new-patient equivalent exists.
Typical 99202 encounters involve one self-limited or minor problem in a patient the practice has not seen within the past three years. Problem visits billed at 99202 might include a minor skin irritation or an insect bite treated at an urgent care clinic.
Is the patient actually new?
Under CPT, a new patient is one who has not received professional services from the physician or QHP, or from another physician or QHP in the same specialty and subspecialty at the same group practice, within the past three years. Medicare counts any E/M service or other face-to-face service, such as a surgical procedure, from the physician or group practice (same physician specialty) in the previous three years.
Three details cause most new-patient errors:
- The group, not the clinician. A patient seen by a different physician of the same specialty in the same group within three years is established, even if the billing provider has never met them.
- Face-to-face services count; some professional components do not. CMS's 2013 instruction notes that a previously billed professional component, such as a lab interpretation, does not by itself make the patient established.
- Nurse practitioners and physician assistants. CPT treats advanced practice clinicians working with physicians as working in the same specialty as those physicians. Medicare contractors review the enrolled specialty: when appealing a new-patient denial, First Coast asks for the specialty and subspecialty of both the billing provider and any nonphysician practitioner the patient saw in the group.
Two pathways: medical decision making vs. time
As with every code from 99202 to 99215, providers may select 99202 based on either MDM or total time. Meeting either pathway is sufficient.
Pathway 1: Straightforward MDM
The encounter must meet at least two of the three MDM elements at the straightforward level:
- Problems addressed: One self-limited or minor problem.
- Data reviewed and analyzed: Minimal or none.
- Risk of patient management: Minimal risk of morbidity from diagnostic testing or treatment, such as rest, fluids, or superficial dressings.
Pathway 2: Total time
Total time must be at least 15 minutes and up to 29 minutes on the date of the encounter. This includes face-to-face and non-face-to-face work by the physician or QHP, such as reviewing intake forms, examining the patient, and documenting. Time spent by clinical staff does not count, and the total time must be documented in the note if billing on the basis of time.
CPT 99202 vs. 99212
The identical MDM level means a straightforward new-patient visit can support 99202 even when documented time falls between 10 and 14 minutes. In that case, select the code on MDM rather than time.
CPT 99202 vs. 99203: Where new patients cross the line
New-patient visits can generate more data to review and analyze than follow-ups, and that work often goes. unbilled. Reviewing notes from a referring provider counts as reviewing prior external notes. Combined with ordering a test, that meets the data element at the low level.
If the same visit also addresses an acute, uncomplicated illness or a stable chronic condition, the encounter supports CPT 99203 on MDM alone. So does a total time of 30 minutes or more.
Common billing mistakes for CPT 99202
- Billing 99202 for an established patient. The most common cause is checking only the billing provider's history rather than every same-specialty provider in the group over the past three years.
- Billing a new-patient nurse visit. No new-patient code exists for clinical-staff-only services; 99211 is limited to established patients.
- Leaving intake data unscored. Outside records reviewed and tests ordered on the date of service can move a visit from 99202 to 99203.
- Selecting by time without stating the time. A time-based 99202 needs an explicit total of at least 15 minutes in the note.
Documentation best practices
A defensible 99202 note shows:
- The single minor or self-limited problem addressed and its management
- Any data reviewed, even when minimal
- The minimal-risk treatment chosen
- When time is used, a statement such as "Total time on the date of service: 18 minutes, including review of intake forms, examination, and documentation"
New-patient status should be confirmed before the visit, at registration, and against all same-specialty encounters in the group for the past three years.
How to ensure accurate billing for CPT 99202
A single 99202 claim is small. A registration workflow that repeatedly misclassifies returning patients as new is not, because each misclassified claim carries the new-patient premium and a known payer edit.
Pre-billing AI chart review reviews every note before the claim is submitted. Models trained on CPT and CMS guidance can flag new-patient codes on patients with a recent same-specialty encounter, and 99202 notes whose documented data and problems support 99203.
Frequently asked questions
What replaced CPT code 99201?
The AMA deleted 99201 effective January 1, 2021, as part of its office E/M guideline revision. CPT 99202 is now the lowest-level new patient office visit.
How many minutes is CPT 99202?
When selected by time, 99202 requires at least 15 minutes of total physician or QHP time on the date of the encounter.
Can a nurse visit be billed for a new patient?
No. CPT 99211, the only E/M code that may not require a physician or QHP, applies only to established patients.
What is the 2026 Medicare reimbursement rate for 99202?
The 2026 national Medicare payment for 99202 is approximately $75 in a non-facility setting and about $41 in a facility setting, before geographic adjustment.
What is the difference between a new and established patient?
An established patient has received professional services from the same physician or QHP, or another of the exact same specialty and subspecialty in the same group, within the past three years. Everyone else is new.
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