CPT 99202 Billing Services
CPT 99202 is a new-patient office visit at the straightforward level — the entry point for a first encounter with a low-complexity problem. Since 2021 it is chosen by either total time (15–29 minutes) or medical decision making, so clean documentation of one or the other is what protects the claim.
Get a free 99202 billing reviewHow 99202 gets billed cleanly
Each step is documented — miss one and the claim is denied.
What CPT 99202 covers
99202 reports the lowest-level new-patient office or outpatient visit. Because it is a new-patient code, the three-year rule applies: the patient must not have been seen by the same provider (or another provider of the same specialty in the group) within the previous three years. Getting that new-vs-established call right up front is the first place 99202 claims are won or lost.
Under the 2021 office-visit rules you may select the level by total time on the date of the encounter (15–29 minutes, face-to-face and non-face-to-face combined) or by straightforward medical decision making. History and exam no longer set the level — they are performed as clinically appropriate but are not counted. We make sure the note supports whichever path was used.
It fits a new patient with a single, self-limited or minor problem — a simple rash, an uncomplicated symptom, a quick evaluation — where little data is reviewed and risk is minimal.
Billing requirements at a glance
| Requirement | What EnVisionMD verifies before submitting |
|---|---|
| New-patient status | No visit with the provider or same-specialty group in the prior 3 years — otherwise an established code (99211–99215) applies. |
| Time or MDM basis | Either total time of 15–29 minutes on the encounter date, or straightforward MDM — the note must clearly support the one chosen. |
| Medical necessity | A documented reason for the visit; the presenting problem should match a straightforward level of care. |
| Chief complaint & plan | A clear reason for the encounter and an assessment/plan, even for a minor problem. |
Common 99202 denials — and how we prevent them
| Why it is flagged | How we avoid it |
|---|---|
| Billed as new but patient is established | We check the 3-year, same-specialty history before submitting so a new-patient level is never billed for an established patient. |
| Level not supported | If neither time nor MDM is documented, we query before the claim goes out rather than letting it deny. |
| Same-day E/M with a procedure | When a minor procedure is done the same day, we confirm a separately identifiable service and apply modifier 25 only when the note supports it. |
Related codes we also bill
Billing rarely uses one code alone — these sit alongside 99202, each with its own page.
How EnVisionMD RCM bills 99202 for your practice
We run billing end to end — eligibility, POS and modifiers, time and medical-necessity documentation, prior-auth tracking and clean claim submission — so 99202 gets paid and stays off the auditor’s radar.
Request my free 99202 billing reviewCPT 99202 — frequently asked questions
Either one. Since 2021 you can select an office visit by total time (15–29 minutes for 99202) or by straightforward medical decision making — whichever the documentation supports.
No professional face-to-face service from the same provider, or another provider of the exact same specialty and subspecialty in the group, in the previous three years.
Yes, when payer telehealth rules are met — typically with place of service 10 or 02 and the correct modifier for the plan.
You perform them as clinically appropriate, but they no longer determine the level — time or MDM does.