The 99202 CPT code is more than just a billing detail; it’s the backbone of many low-complexity, new patient visits in outpatient settings. Whether you’re a solo provider or a billing manager at a multi-specialty clinic, understanding the 99202 CPT code description, time requirements, cost, and reimbursement is key to accuracy, compliance, and fair compensation.
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.
99202 CPT code is used to bill for new patient office or other outpatient visits with low medical decision-making (MDM) and/or 15–29 minutes of total time spent on the encounter (as updated by 2021 E/M guidelines).
It’s often used when patients present with straightforward concerns, such as routine follow-ups or single-system symptoms.
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:
Total time spent: 21 minutes.
Code billed: 99202 CPT code
This is a textbook case for 99202—low complexity, new patient, under 30 minutes.
The time requirement is based on total time spent on the day of the encounter, including:
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.
On average, Medicare reimbursement for 99202 ranges between $75–$90, depending on geographic region and payer. Commercial insurance may reimburse slightly more.
Pro tip: Reimbursement varies based on:
99202 CPT code reimbursements tend to be lower than 99203 or 99204, but they accurately reflect the value of quick, low-complexity visits.
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:
In this case, use:
Clear documentation is your best defense. If you’re ever unsure, ask your billing support team (or us, we’re here to help).
There is no specific age restriction for 99202. It can be billed for any new patient—child, adolescent, adult, or elderly—as long as the visit criteria are met.
That said, pediatric visits often require more time and complexity, making 99203 or 99204 more appropriate in many cases.
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.
If billed directly, patients may see charges ranging from $100 to $160, depending on:
Many clinics offer sliding scale rates or payment plans, especially for uninsured or underinsured patients.
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.
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:
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.
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:
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:
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.
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