How to Use 99202 CPT Code - A 2025 Guide for Healthcare Billing

A professional women catchup the clipboard thinkgin about the 99202 cpt code for billing process.

Key Takeaways

  • 99202 is used for new patient visits requiring 15–29 minutes with straightforward medical decision-making.

  • Providers must document total time and services provided on the encounter date.

  • Modifier 25 may apply when a separate, unrelated procedure is performed during the same visit.

  • 99202 is valid for all ages and remains active in 2025.

  • Average Medicare reimbursement ranges between $75–$90, varying by region and payer.

As a billing specialist who has helped countless providers navigate code changes, I’ve seen how simple misunderstandings about 99202 can lead to claim denials, underpayments, and patient confusion.

What is the 99202 CPT Code?

CPT Code 99202 is part of the Evaluation and Management (E/M) codes defined by the American Medical Association (AMA). It is used for new outpatient visits involving:

  • Straightforward medical decision-making, and/or

  • 15–29 minutes of total time spent with the patient on the encounter date.

Note: These time-based guidelines were updated in 2021 and remain valid for 2025.

It’s typically used when a new patient presents with a simple concern, like mild seasonal allergies, a rash, or general health questions, and the provider spends under 30 minutes evaluating, educating, and planning care.

Services Covered Under 99202 CPT Code

Here’s a breakdown of what services typically fall under a 99202-coded visit:

ServiceDescription
Patient HistoryReview of presenting complaint and relevant medical background
Physical ExamFocused exam based on symptoms
Medical Decision-MakingStraightforward assessment and care planning
CounselingAdvice or education about the condition or treatment
DocumentationAll services and findings are recorded for compliance

Who Can Use the 99202 CPT Code?

CPT 99202 can be billed by various licensed healthcare professionals when seeing new patients in outpatient settings:

  • Family Physicians

  • Internists

  • Pediatricians (if the visit meets time and complexity guidelines)

  • Specialists (e.g., dermatologists, orthopedists, cardiologists)

Just remember: it’s strictly for new patients and low-complexity cases.

Contact US

Name

Let's Talk

+1 (917) 994-9941

3811 Ditmars Blvd# 1124,

Astoria, NY 11105

99202 CPT Code Example - What a Real Visit Looks Like

Let’s say a 28-year-old new patient visits a family practice clinic for mild seasonal allergies and wants advice on over-the-counter treatments.

The provider:

  • Reviews the history
  • Performs a focused physical exam
  • Offers education and non-prescription options
  • Documents everything

Total time spent: 21 minutes.
Code billed: 99202 CPT code

This is a textbook case for 99202—low complexity, new patient, under 30 minutes.

99202 CPT Code Time Limit and Guidance

The time requirement is based on total time spent on the day of the encounter, including:

  • Reviewing patient records
  • Taking a history
  • Performing the exam
  • Counseling
  • Documenting and coordinating care 

If the total time is under 15 minutes, the visit may not qualify for 99202. Consider billing a non-face-to-face service, or not billing at all, depending on the case.

99202 CPT Code Reimbursements - What Can You Expect?

Insurance TypeEstimated Reimbursement
Medicare$75 – $90
Medicaid$65 – $80
Private Payers$85 – $100+

99202 CPT code reimbursements tend to be lower than 99203 or 99204, but they accurately reflect the value of quick, low-complexity visits.

99202 CPT Code Modifier 25 - When and How to Use It

Modifier 25 is used when a significant, separately identifiable E/M service is provided on the same day as a procedure or service.

Example:

A new patient comes in for a flu shot but also discusses unrelated skin rash symptoms. The provider:

  • Administers the shot
  • Evaluates the rash
  • Documents everything clearly

In this case, use:

  • Total time spent: 21 minutes
    Correct code billed: 99202

  • Clear documentation is your best defense. If you’re ever unsure, ask your billing support team (or us, we’re here to help).

Age Limit for 99202 CPT Code

There’s no age restriction for 99202. It can be used for:

  • Pediatric patients

  • Adolescents

  • Adults

  • Elderly patients

What matters is the time and complexity, not age. Pediatric visits may often require 99203 or 99204 if they’re more complex.

Common Mistakes to Avoid When Billing 99202

Billing 99202 may seem simple, but here are a few pitfalls to watch out for:

  • Not documenting the total time spent

  • Billing 99202 for returning patients: This code is meant for new patient visits only. Established patients should be billed using codes 99211 through 99215.

  • Not documenting key elements of the visit: Omitting important details, such as history, physical exam findings, or the treatment plan, can result in claim denials or payer audits.

  • Forgetting Modifier 25 when a separate service is performed

  • Using 99202 for cases that are too complex: If the patient presents with multiple chronic conditions or the provider spends more than 30 minutes, codes like 99203 or 99204 may be more accurate.

Tip: Detailed documentation is your best protection against denials and compliance issues.

Is 99202 CPT Code Deleted or Still Valid in 2025?

No, 99202 has not been deleted. It remains active and billable as of 2025.

However, always verify the latest AMA CPT code updates and payer policies, as guidelines can evolve. The 2021 E/M overhaul already simplified levels 99202–99215, and future updates may refine them further.

99202 CPT Code Cost for Self-Pay Patients

If billed directly, patients may see charges ranging from $100 to $160, depending on:

  • Location
  • Clinic pricing
  • Provider specialty

Many clinics offer sliding scale rates or payment plans, especially for uninsured or underinsured patients.

99202 vs. 99203 CPT Code - What's the Difference?

Feature

99202

99203

Time

15–29 minutes

30–44 minutes

MDM

Straightforward

Low

Reimbursement

Lower

Higher

Use case

Simple new concerns

Chronic or dual issues

Choose the code that accurately reflects your work—upcoding is risky, and undercoding sells yourself short.

Final Thoughts

The 99202 CPT code may seem basic, but it plays a critical role in accurate, fair reimbursement, especially for primary care and urgent care providers.

As a medical billing company that supports OB/GYNs, family medicine practices, and specialists alike, we know firsthand how proper coding boosts:

  • Claim acceptance
  • Provider revenue
  • Patient satisfaction

Need Help Navigating 99202 or E/M Billing?

Let us simplify it for you. From modifier usage to payers’ quirks, we offer expert billing services with a human touch.

Disclaimer:

This content is for informational purposes only and does not constitute legal, billing, or medical advice. Always refer to the latest AMA CPT guidelines and your payer’s policies for coding accuracy.

Frequently Asked Questions (FAQs)

99202 is used when a new patient visits a provider for a low-complexity issue that takes 15–29 minutes. Think of a young adult coming in for mild allergy symptoms or a first-time wellness conversation. As a billing specialist, I’ve seen this code commonly used in family practice, internal medicine, and urgent care.

Real tip: If the visit feels straightforward and under 30 minutes, this is often your go-to code.

It depends on the patient’s condition. Here are common pairings we see in real-life practices:

  • J30.9 – Allergic rhinitis (unspecified)
  • R51.9 – Headache (unspecified)
  • Z00.00 – General adult exam without abnormal findings
  • F41.9 – Unspecified anxiety disorder

In our billing audits, we emphasize aligning the ICD-10 diagnosis with the level of service. A mismatch can lead to denials—even for something that feels routine.

No. According to 2021 E/M guidelines, 99202 requires 15–29 minutes of total time spent on the date of service. If the visit is under 15 minutes and lacks medical decision-making complexity, it may not meet billing requirements.

I once worked with a provider who regularly saw quick walk-ins but was billing 99202 anyway. Their claims kept getting denied. After documentation training, their approval rate improved significantly.

Yes, 99202 is still valid in 2025. It was updated (not deleted) during the 2021 E/M code overhaul to focus on time and decision-making rather than history and physical exam checklists.

Still, we always advise our provider clients to check annual CPT updates and payer-specific rules. Things evolve fast in healthcare billing.

It comes down to time and complexity:

  • Use 99202 for visits with 15–29 minutes and straightforward problems.
  • Use 99203 if the time hits 30–44 minutes or involves low-complexity MDM (like managing two conditions or starting a medication).

We helped a clinic streamline this decision by creating a simple coding chart and tying it to their EMR’s time-tracking tools.

Use Modifier 25 when a provider performs a significant, separately identifiable E/M service on the same day as another procedure.

Example:
A patient comes in for a routine vaccination but also brings up a rash that requires evaluation.
Bill: 90471 (vaccine) + 99202–25 (rash evaluation)

Always document both services clearly. As a biller, I flag 99202–25 combos for providers during audits to ensure proper documentation is in place before submitting.

That depends on insurance. Medicare reimbursement for 99202 typically ranges $75–$90. For self-pay patients, the cost can be $100–$160, depending on your region and specialty.

We recommend creating transparent pricing sheets and offering pre-visit billing estimates—especially for clinics seeing a lot of uninsured or high-deductible plan patients.

There’s no age restriction on 99202. It’s appropriate for any new patient, regardless of age, as long as the service fits the time and complexity criteria.

However, in our experience, pediatric visits often require more in-depth counseling, meaning 99203 or even 99204 may be more accurate. We’ve worked with pediatric practices to fine-tune their coding strategy around visit types and parent consultations.

Discover Cures Medical Billing Services Across Different States

Your Success Is Our Success

We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.

Start free 30 Days Trial Now

Contact Our RCM

© 2024 Created Cures Medical Billing Solutions, All copyrights Reserved 

×
Icon

Get a FREE Medical Billing Audit

×

Book A Free Medical Billing Audit