If you’re a healthcare provider or medical biller, you know that the 99205 CPT code is more than just a number; it’s one of the most complex and high-reimbursing E/M codes in outpatient care. But getting paid for it? That requires accurate documentation, the right medical decision-making (MDM) level, and time tracing.
At Cures, we’ve worked closely with practices across various specialties, including psychiatry and internal medicine, to help them bill 99205 successfully and compliantly. Here’s what you need to know from both a real-world billing and clinical documentation perspective.
CPT code 99205 is used for a new patient office visit that’s both very detailed and time-consuming. It is the high-level code for evaluating and managing a new patient in an outpatient setting.
You should use 99205 when:
Because of the time and complexity involved, it also comes with higher reimbursement, but that means you need to document clearly to avoid denials.
CPT Code 99205 is defined as:
A workplace or other outpatient visit for the assessment and management of a new patient is needed:
This code sits at the top of the E/M code level for new patient visits, just above the 99204 CPT code.
If you choose this code based on time, here’s what to know:
This extended time reflects a complex patient scenario, think multisystem chronic conditions, coordination of care, or comprehensive mental health evaluations.
To bill 99205 by MDM, documentation must show:
We’ve seen providers under-document their complexity, leading to downcoding or denials. Our billing experts at Cures Medical Billing Services often catch missing components during audits.
This code pays significantly higher than lower-level E/M codes, but it comes with scrutiny.
Category | Approximate Values |
Medicare Reimbursement (2024) | ~$224–$245 |
RVUs | ~3.17 |
Private Payers | Often higher, depending on the contract |
Psychiatry 99205 Usage | Accepted for complex diagnostic visits |
Note: Always verify payer-specific policies, especially for televisit CPT scenarios.
In our billing experience, many providers try to justify 99205 only with time, which isn’t wrong—but often risky. Why?
Because payers audit high-level time-based codes more aggressively. If your chart says “spent 65 minutes” but lacks detailed documentation on patient complexity, it can raise flags.
Pro tip: If you’re using 99205 CPT code for psychiatry, include behavioral assessments, medication risk factors, and coordination notes with outside providers.
Feature | 99204 | 99205 |
MDM Level | Moderate | High |
Time | 45–59 minutes | 60–74 minutes |
Reimbursement | Lower | Higher |
If you’re hovering between 99204 and 99205, ask:
If yes, 99205 might be justified.
At Cures Medical Billing Services, we:
Need help? We specialize in psychiatry, family medicine, internal medicine, and more.
Billing for the 99205 CPT code doesn’t have to be complicated; it does demand precision. Whether you’re a provider juggling complex patients or a billing team managing payer policies, it all comes down to proper documentation, justified time, and understanding the full picture of what this high-level E/M code represents.
Ready to code with confidence? Visit us at Cures Medical Billing Services or call for a free E/M coding consultation. We help you get the reimbursement you deserve without the audit stress.
Use 99205 when the patient visit contains high-level medical decision making or 60–74 minutes of total time spent. This is typically for complex cases that require deeper analysis, risk assessment, and coordination of care.
Yes, 99205 can be billed for a telehealth visit if the payer allows it and if the documentation supports the time or complexity requirements. Don’t forget to add modifier 95 or POS 10 as needed based on payer guidelines.
If documentation doesn’t clearly support the code, insurers may down code it to 99204 or even 99203, which lowers your reimbursement. In some cases, frequent overuse or errors can trigger an audit. Proper charting protects your payment—and your practice.
Both are valid, but time-based coding is ideal if you spend the required minutes and document all activities clearly. MDM-based coding is often preferred when time is close to the threshold or when clinical complexity is high.
Absolutely, psychiatrists can use 99205, especially during detailed intake evaluations. The time and decision-making involved in psychiatric diagnoses, risk assessments, and treatment planning often justify this code when documented appropriately.
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