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CPT Code 99202 Made Simple: Essential Guidelines for Healthcare Providers

Stanley Efrem

Aug 31, 2025

Accurate billing with CPT code 99202 directly impacts your practice's financial health and compliance standing. Mental health providers and medical practitioners rely on this code daily for new patient evaluations [12].

CPT code 99202 covers new patient visits requiring evaluation and management services [9]. These appointments span 15-29 minutes of total encounter time [8]. Medicare reimbursement stood at $80.91 in 2022 [9], with projections showing a decline to $69.87 by 2025 [10]. The reimbursement figures provided are illustrative. Medicare rates are updated annually.

Incorrect coding puts your reimbursement at risk. Lost time and reduced payments follow billing errors [12].

This guide provides clear direction for using CPT code 99202 correctly. You'll maintain compliance while securing appropriate reimbursement for your services.

Understanding CPT Code 99202

The Current Procedural Terminology system establishes standardized billing codes across healthcare services. CPT code 99202 stands as one of the most frequently used evaluation and management codes for new patients.

What is CPT Code 99202?

CPT code 99202 applies to office or outpatient visits for new patient evaluation and management [8]. The code covers services requiring medically appropriate history and examination paired with straightforward medical decision-making [11]. Primary care physicians, dermatologists, and mental health professionals use this code for initial patient encounters with minimal complexity [3].

Time and Complexity Requirements

Specific parameters govern proper 99202 billing. Total encounter time must fall between 15-29 minutes on the service date [11]. Most sessions average 20 minutes [10].

Straightforward medical decision making forms the complexity requirement [8]:

Minimal problems addressed during the visit
Limited data review needed
Low risk management decisions

You can select this code based on medical decision-making complexity or total time spent [12]. The code also covers services delivered when physician presence isn't required [9].

New Patient Definition

New patient status requires clear identification. A new patient hasn't received professional services from your physician—or another same-specialty physician in your group practice—within the past three years [11]. Professional services means "face-to-face services rendered by a physician and reported by a specific CPT code" [12].

Specialty designation determines patient status in multispecialty practices. Patients seeing different specialty providers may still qualify as new [12]. Single-specialty practices must use established patient codes if any group physician treated the patient within three years [12].

When and How to Use Procedure Code 99202

The 2021 evaluation and management coding revisions provide healthcare providers with greater flexibility when selecting appropriate codes. CPT code 99202 offers two clear pathways for determining code application to patient encounters.

Time-based vs. decision-making-based coding

The 2021 coding updates allow you to select procedure code 99202 using either total time spent or medical decision-making (MDM) complexity [8]. Time-based coding requires total time between 15-29 minutes [9]. This total encompasses both face-to-face and non-face-to-face activities performed on the service date [10].

Your billable time includes patient preparation, record reviews, examinations, patient counseling, medication or test orders, health record documentation, and result interpretation [8]. Exclude time spent by nurses or medical assistants, travel time, or separately billed services [11].

Examples of appropriate use cases

Procedure code 99202 fits scenarios with uncomplicated issues requiring minimal evaluation. Appropriate cases include:

Minor acute conditions like sore throats or ear pain needing basic treatment [12]
Routine health concerns including mild fatigue or minor skin irritation [12]
Initial consultations for well-controlled chronic conditions [12]
Mental health evaluations with straightforward decision-making [13]

What makes a visit 'straightforward'?

Straightforward visits require specific elements across three MDM components for proper 99202 CPT code application. Problems addressed must be minimal, typically involving one self-limited or minor problem [1]. Data reviewed should be minimal or none [5]. Risk of complications or morbidity from additional testing or treatment must remain minimal [5].

A practical example helps clarify this distinction: an otherwise healthy patient presenting with cough and congestion from a common cold represents an appropriate 99202 case [1]. A sinus infection requiring antibiotics would warrant a higher-level code due to increased risk [1].

Document total time spent clearly when using time-based coding. Include specific activities performed to support your code selection [11].

Documentation Guidelines for Accurate Billing

Proper documentation ensures successful reimbursement for CPT code 99202. The 2021 revisions provide greater flexibility while maintaining essential compliance standards.

Required elements in patient records

Documentation requirements changed substantially with the 2021 updates. You no longer need to document history and physical exam elements to determine service level [8]. Your medical records must contain:

A medically appropriate history and/or examination tailored to the patient's presenting problem [11]
Clear documentation of problems addressed during the encounter
Details of data reviewed and analyzed
Risk assessment of patient management decisions

Procedure code 99202 documentation must demonstrate straightforward medical decision-making with minimal problem complexity [14].

How to document time spent

Time-based coding requires precise documentation of minutes spent on the service date [6]. Include these elements:

Total time statement: Record exact time (e.g., "Total time spent: 18 minutes") [11] Activity breakdown: List activities performed, though not mandatory [6]

Only time spent on the calendar date of service counts toward code selection [2]. This covers face-to-face and non-face-to-face activities including record review, documentation, and care coordination [8].

Tips for supporting medical necessity

Medical necessity documentation for procedure code 99202 requires specific details:

State the visit reason clearly [3] Document how examination and decision-making address the presenting problem Note specific reasons for medication adjustments beyond simply stating "reviewed" [4] Record activities performed, particularly non-face-to-face work [11]

Strong documentation supports proper coding and provides audit protection for your practice [15].

Comparing 99202 with Other E/M Codes

Understanding the distinctions between E/M codes helps you select the most appropriate option for each patient encounter. Code selection directly affects your reimbursement and compliance standing.

99202 vs 99203: Key differences

CPT code 99202 and 99203 differ primarily in complexity and time requirements. Code 99202 requires straightforward medical decision-making, while 99203 demands low complexity decision-making [14]. Time requirements also vary: 99202 covers visits lasting 15-29 minutes, and 99203 encompasses longer visits of 30-44 minutes [16].

The problems addressed differ as well. Code 99202 typically handles one minor problem, whereas 99203 addresses two or more minor problems or one stable chronic illness [16]. These distinctions matter for proper reimbursement.

Why 99201 was deleted

CPT code 99201 was deleted from the code set effective January 1, 2021 [17]. The elimination occurred because both 99201 and 99202 required straightforward medical decision-making, creating unnecessary redundancy [17]. Since 99201 was rarely used and overlapped substantially with 99202, its deletion streamlined billing processes for healthcare providers [18].

Choosing the right code for visit complexity

Code selection depends on medical decision-making complexity or total time spent [7]. The CPT MDM table categorizes office/outpatient E/M codes by complexity level:

Straightforward: 99202/99212
Low: 99203/99213
Moderate: 99204/99214
High: 99205/99215 [5]

Your documentation must align with these complexity parameters to ensure accurate code selection and appropriate reimbursement.

Conclusion

CPT code 99202 mastery protects your practice's financial stability. Proper coding requires clear understanding of both time-based and complexity-based billing approaches.

The 2021 revisions provide flexibility in code selection. You can choose between total time documentation or medical decision-making complexity assessment. Patient status determination follows the three-year rule, directly affecting your code choice.

Quality documentation drives reimbursement success. Your records must demonstrate medical necessity while reflecting actual services provided. Attention to these details prevents audit issues and payment denials.

Code distinctions matter for your bottom line. Recognizing the difference between straightforward and low-complexity decision-making affects your practice revenue directly.

This understanding positions you to bill confidently and maintain compliance. Your evaluation and management coding will support appropriate compensation while meeting regulatory standards.

Key Takeaways

Understanding CPT code 99202 is crucial for healthcare providers to ensure accurate billing and maximize appropriate reimbursement for new patient encounters.

• CPT 99202 applies to new patients with straightforward medical issues requiring 15-29 minutes of total encounter time

• You can bill based on either total time spent or medical decision-making complexity since 2021 coding updates

• Documentation must clearly reflect straightforward decision-making with minimal problem complexity and medical necessity

• New patients are defined as those who haven't received professional services from your specialty within three years

• Choose 99202 over 99203 when addressing one minor problem versus multiple problems or stable chronic conditions

Proper implementation of these guidelines protects your practice from audits while ensuring you receive appropriate compensation for evaluation and management services provided to new patients.

FAQs

What is CPT code 99202 used for?

CPT code 99202 is used for office or outpatient visits involving the evaluation and management of new patients. It applies to encounters that require a medically appropriate history and/or examination combined with straightforward medical decision-making.

How long should a visit billed under CPT code 99202 last?

A visit billed under CPT code 99202 should last between 15-29 minutes of total time spent on the date of the encounter. This includes both face-to-face and non-face-to-face activities related to patient care.

What qualifies as straightforward medical decision-making for CPT code 99202?

Straightforward medical decision-making for CPT code 99202 involves addressing minimal problems, reviewing limited data, and making management decisions with low risk. Typically, it applies to uncomplicated issues requiring minimal evaluation.

How does CPT code 99202 differ from 99203?

The main differences are in complexity and time. CPT code 99202 requires straightforward medical decision-making and covers visits lasting 15-29 minutes, while 99203 demands low complexity decision-making and encompasses visits of 30-44 minutes.

What documentation is required for billing CPT code 99202?

For billing CPT code 99202, documentation should include a medically appropriate history and/or examination, clear details of problems addressed, data reviewed, and risk assessment. If using time-based coding, record the total minutes spent and briefly list activities performed.