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.
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.
Here’s a breakdown of what services typically fall under a 99202-coded visit:
| Service | Description |
|---|---|
| Patient History | Review of presenting complaint and relevant medical background |
| Physical Exam | Focused exam based on symptoms |
| Medical Decision-Making | Straightforward assessment and care planning |
| Counseling | Advice or education about the condition or treatment |
| Documentation | All services and findings are recorded for compliance |
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.
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.
| Insurance Type | Estimated 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.
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:
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).
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.
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.
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?
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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.
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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