CPT 99202: New Patient Visit, Simple MDM

• CPT Codes
• 99202

CPT 99202: New Patient Visit, Simple MDM

CPT code 99202 for new patient office visits with straightforward MDM. Billing rates, documentation tips, and behavioral health guidance.

Quick Reference

Code

99202

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

7 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 99202: New Patient Office Visit

CPT code 99202 describes an office or other outpatient visit for the evaluation and management of a new patient. It requires straightforward medical decision making and has a typical time of 15-29 minutes. Since the deletion of 99201 in 2021, this is now the lowest-level E&M code available for new patient encounters, making it one of the most commonly billed codes in behavioral health settings.

Definition and Purpose

CPT code 99202 falls within the office/outpatient E&M code family (99202-99215) and is specifically designated for new patients. Under the current E&M framework established in 2021, code selection is based on either the level of medical decision making or the total time spent on the encounter date.

For 99202, straightforward medical decision making means:

Alternatively, providers may select 99202 based on total time of 15-29 minutes spent on the date of the encounter. This time includes both face-to-face and non-face-to-face activities such as preparing to see the patient, reviewing records, ordering tests, documenting the encounter, and coordinating care.

• Number and complexity of problems: One self-limited or minor problem
• Amount and complexity of data: Minimal or no data to be reviewed and analyzed
• Risk of complications: Minimal risk of morbidity from additional diagnostic testing or treatment

When to Use 99202 in Behavioral Health

In behavioral health treatment settings, CPT 99202 is appropriate for several types of new patient encounters:

It is important to note that many behavioral health intake encounters involve more complexity than straightforward MDM. If the provider reviews significant outside records, addresses multiple conditions, or manages medications with moderate risk profiles, a higher-level code such as 99203 or 99204 may be more appropriate.

• Initial brief assessments where a new patient presents with a single, straightforward concern such as a request for medication management for a stable, previously diagnosed condition
• Intake screening visits where the provider evaluates a new patient’s suitability for a specific program with minimal complexity
• Consultation visits where a new patient is seen for a focused evaluation of a single behavioral health issue with clear, low-risk management options
• Medication review appointments for new patients transferring care with stable prescriptions and no complicating factors
• Brief initial evaluations in outpatient settings where the clinical picture is clear and the treatment plan is straightforward

Documentation Requirements

To support a claim for 99202, your documentation must establish either straightforward MDM or 15-29 minutes of total time. The following elements should be present in the medical record.

For MDM-based billing:

For time-based billing:

General documentation best practices:

• Chief complaint and reason for the visit
• Assessment identifying one self-limited or minor problem
• A straightforward treatment plan with minimal risk
• Notation of any data reviewed, even if minimal
• Clear indication this is a new patient encounter

• Statement that time is the controlling factor for code selection
• Total time spent on the date of the encounter (must be 15-29 minutes)
• Description of activities performed, which may include reviewing records, face-to-face evaluation, care coordination, and documentation
• Clinical assessment and plan

• Document the patient’s status as a new patient (no professional services from the provider or same-specialty provider in the same group within the past three years)
• Include the date of service
• Ensure the provider signs and dates the note
• Use specific, measurable language rather than vague descriptions
• Avoid cloned or templated notes that do not reflect the individual encounter

Billing and Reimbursement

Step-by-Step Billing Process

• Verify new patient status. Confirm the patient has not been seen by the provider or a same-specialty provider in the group within the past three years.
• Determine the appropriate code level. Evaluate whether the MDM is straightforward or whether time-based selection yields a more accurate code.
• Complete documentation. Ensure all required elements are documented before submitting the claim.
• Assign the correct place of service code. Use POS 11 for office visits, POS 02 for telehealth, or the applicable code for your setting.
• Apply modifiers if needed. Add modifier 95 for synchronous telehealth if required by the payer.
• Submit the claim. Bill 99202 with the appropriate diagnosis codes supporting medical necessity.
• Follow up on denials. If the claim is denied, review the reason code and resubmit with additional documentation if appropriate.

Reimbursement Rates

As of March 2026, approximate reimbursement rates for CPT 99202 are:

These rates are approximate and subject to annual updates. Always verify current rates with your specific payers and geographic adjusters.

• Medicare: Approximately $72 (national average; varies by geographic locality)
• Medicaid: Varies by state, often similar to or slightly below Medicare rates
• Commercial payers: Typically 110-150% of Medicare rates, depending on the contract

Common Modifiers

The following modifiers are commonly used with CPT 99202:

• Modifier 25 — Significant, separately identifiable E&M service performed on the same day as another procedure. Use when you perform a separately billable procedure (such as an injection) during the same visit.
• Modifier 95 — Synchronous telehealth service rendered via real-time interactive audio and video. Required by some payers for telehealth encounters.
• Modifier GT — Via interactive audio and video telecommunications systems. Some payers still use GT instead of or in addition to modifier 95.
• Modifier AI — Principal physician of record. Used in inpatient settings to identify the admitting physician.

Modifier Guidelines

• Do not append modifier 25 unless a significant, separately identifiable service was performed beyond the E&M visit itself.
• When billing telehealth, verify which modifier your specific payer requires, as policies vary.
• Never use modifier 25 solely to increase reimbursement; it must reflect genuinely separate services with distinct documentation.

Compliance Considerations

Key Compliance Requirements

• Medical necessity. Every claim for 99202 must be supported by a diagnosis that justifies the encounter. The documented assessment and plan must align with the billed diagnosis codes.
• New patient verification. Billing 99202 for an established patient is a compliance violation. Implement systems to verify new patient status before the encounter.
• Accurate time documentation. If billing based on time, the documented time must reflect actual time spent. Rounding up or inflating time constitutes fraud.
• Appropriate code level. Do not routinely default to 99202 for all new patient visits. Some encounters may warrant a higher code, and others may not meet the criteria for any new patient E&M code.

Common Pitfalls to Avoid

• Upcoding. Billing 99203 or higher when the encounter only supports straightforward MDM inflates reimbursement and is a compliance risk.
• Downcoding. Routinely billing 99202 when the documentation supports a higher level results in lost revenue and may also attract audit attention as an outlier pattern.
• Missing documentation. Submitting claims without adequate documentation to support the code level is the most common cause of post-payment recoupment.
• Incorrect patient status. Billing a new patient code for a returning patient, or an established patient code for a genuinely new patient, creates claim processing errors and potential compliance issues.

Audit Preparedness

Maintain documentation that can withstand a retrospective audit. For each 99202 encounter, an auditor should be able to confirm:

• The patient was genuinely new
• The MDM was straightforward (or time was 15-29 minutes)
• A medically necessary reason for the visit existed
• The assessment and plan were consistent with the documented complexity

Related Billing Codes

• 96165
• 96372
• 99201
• 99203
• 99204
• 99205

Common questions

Official sources

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