- Key Takeaways
- CPT code 99202 reports the entry-level new patient office visit, requiring straightforward medical decision making or 15 to 29 minutes of total time on the encounter date.
- 99201 was deleted on January 1, 2021, and CPT directs reporting 99202 in its place, so 99202 is now the lowest new patient office code.
- Because a new patient visit involves establishing care and gathering history, a truly straightforward 99202 is uncommon, and many are actually low-complexity 99203 visits.
- Straightforward MDM means minimal complexity: one self-limited or minor problem, minimal or no data reviewed, and minimal risk from the management decisions.
- The AMA sets the time band at 15 to 29 minutes; one stable chronic illness or two minor problems raises the visit to low complexity and 99203.
99202 is the floor of the new patient office visit range, and it got there by absorbing another code. Effective January 1, 2021, CPT deleted 99201 and directed providers to report 99202 in its place, since both described straightforward decision-making and differed only by history and exam requirements that no longer matter. That makes 99202 the lowest new patient level available. It also makes it the one practices most often overuse, because a genuinely straightforward new patient visit is less common than the reflex to bill the safe low code suggests.
Current as of 2026. Always verify code status and payment with your specific payer, since policies change.
What 99202 is: the entry-level new patient visit
99202 is an office or other outpatient visit for a new patient, supported by straightforward medical decision making or 15 to 29 minutes of total time on the date of the encounter. It is the Level 2 new patient code and, since the deletion of 99201, the lowest level in the range. It fits a genuinely minimal first visit: a single self-limited or minor problem, little or no data to review, and low-risk management.
Because it is a new patient code, the 3-year, same-specialty, same-group rule applies, and getting that wrong is its own denial. We cover that in our guide to CPT code 99204.
What happened to 99201
If you still see 99201 on a superbill or in an old template, it needs to come out. 99201 was deleted on January 1, 2021. Before then, 99201 and 99202 both described straightforward MDM and were distinguished only by the extent of the history and exam. When the 2021 overhaul made history and exam irrelevant to code selection, the two codes had nothing left to separate them, so 99201 was retired and 99202 became the single straightforward-MDM new patient code. Any lingering 99201 use should be updated to 99202 to avoid rejected claims.
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Why a true 99202 is uncommon
Here is the point the definition pages skip. Straightforward MDM means minimal: one minor problem, minimal or no data, minimal risk. But a new patient encounter, by its nature, involves establishing the relationship, taking a history, and orienting to the patient’s background. That work often pushes the visit past minimal into low complexity, which is 99203.
So while 99202 is a valid, appropriate code for a genuinely simple first visit, such as a healthy young adult with a single minor complaint, it is also the code practices most often overuse. Defaulting new patients to 99202 to play it safe frequently means undercoding a visit that met 99203, and across a panel that is real revenue left behind. The fix is the same as at every level: pick the code by what was actually documented, not by caution.
Straightforward MDM: what actually qualifies
Straightforward MDM means reaching the minimal level in at least two of three elements:
- Problems addressed: one self-limited or minor problem.
- Data reviewed: minimal or none.
- Risk: minimal risk from the workup or treatment.
If the visit exceeds any of these, one stable chronic illness, two minor problems, ordering and reviewing tests, it has likely moved to low complexity and 99203.
In practice, a genuinely straightforward new patient visit tends to involve a single minor or self-limited complaint, such as an acute upper respiratory infection (J06.9), contact dermatitis (L25.9), or an uncomplicated insect bite (S30.860A). If a stable chronic illness like hypertension (I10) is being evaluated and managed, the visit has usually moved to low complexity and 99203, not 99202. As always, the diagnosis code supports the picture but does not set the level; the documented decision-making does.
The boundary that matters: 99202 vs 99203
This is where 99202 is won or lost. The step from 99202 to 99203 is the step from minimal to low complexity:
- One self-limited problem, minimal data, minimal risk, or 15 to 29 minutes, is 99202.
- One stable chronic illness, or two or more minor problems, with limited data and low risk, or 30 to 44 minutes, is 99203.
A new patient with well-controlled hypertension whose plan is reviewed and continued is already a stable chronic illness addressed, which supports 99203, not 99202. Our guide to CPT code 99203 covers that level in detail.
Documentation payers expect
A defensible 99202 note should show:
- That the patient meets the new patient definition
- A medically appropriate history and examination (documented, but not the basis for the level)
- Either two minimal-level MDM elements or a clear statement of total time between 15 and 29 minutes
- A diagnosis linked to the encounter
Common billing errors to avoid
- Still using 99201. It was deleted in 2021; report 99202 instead.
- Overusing 99202. If the visit met low complexity or 30 minutes, it is 99203, and defaulting low is undercoding.
- Listing problems instead of addressing them. A diagnosis has to be evaluated or managed to count toward MDM.
- New patient determination errors. Confirm the 3-year, same-specialty, same-group rule before billing a new patient code.
Related codes and modifiers
- The new patient ladder: 99202 (straightforward, 15 to 29 minutes), 99203 (low, 30 to 44 minutes), 99204 (moderate, 45 to 59 minutes), 99205 (high, 60 to 74 minutes).
- 99202 vs 99212: the same straightforward level, split by new versus established status, with a higher time threshold and higher payment on the new patient side.
- Modifier 25 applies when a significant, separately identifiable E/M is billed with a same-day procedure.
- G2211, the Medicare visit-complexity add-on, is billable with 99202 through 99215.
Reimbursement context
99202 is the lowest-paying code in the new patient range under the Medicare Physician Fee Schedule, which is exactly why habitually defaulting to it is costly: a visit that met 99203 billed as 99202 gives up the difference on every encounter. Treat any single figure as illustrative and confirm the current rate for your setting through the CMS Physician Fee Schedule Look-Up Tool, which updates annually.
The bottom line
99202 is the entry point to the new patient range and a legitimate code for a truly simple first visit, but it is also the level practices reach for out of caution when the work supported more. Retire any lingering 99201, bill 99202 only when the visit is genuinely minimal, and move to 99203 when a stable chronic problem or two minor issues are addressed. For practices that would rather not track E/M levels and new-patient rules claim by claim, Neolytix has supported healthcare organizations across the United States for over 14 years, with E/M coding review built into its medical billing services so new patient claims are accurate before they go out.
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This guide reflects Neolytix’s expertise in healthcare revenue cycle management and is intended for educational purposes only. It does not constitute legal or compliance advice. CPT codes and reimbursement rates are periodically updated by the AMA and CMS.
Sources
- American Medical Association. CPT office and outpatient E/M codes (99202 to 99205). https://www.ama-assn.org/practice-management/cpt
- American College of Surgeons. 2021 office and outpatient E/M coding changes (deletion of 99201). https://www.facs.org/for-medical-professionals/practice-management/coding-and-billing/em-coding-billing/officeoutpatient-em-visit-coding-changes/
- Centers for Medicare & Medicaid Services. Physician Fee Schedule Look-Up Tool. https://www.cms.gov/medicare/physician-fee-schedule/search
- AAPC. CPT code 99202 reference. https://www.aapc.com/codes/cpt-codes/99202
Frequently Asked Questions
What is CPT code 99202 used for?
99202 is the entry-level new patient office visit, used when the encounter involves straightforward medical decision making or 15 to 29 minutes of total time. It fits a genuinely minimal visit: one self-limited or minor problem, little or no data reviewed, and low risk. It is the lowest new patient level, one below 99203.
What happened to CPT code 99201?
99201 was deleted effective January 1, 2021. Both 99201 and 99202 described straightforward medical decision making and were separated only by history and exam requirements, which no longer determine the level. CPT now directs providers to report 99202 in place of 99201, so any lingering 99201 use should be updated.
How many minutes is 99202?
On the time pathway, 99202 requires 15 to 29 minutes of total time on the date of the encounter, including chart review, the visit, counseling, coordination, and documentation by the billing provider. Reaching 30 minutes moves the visit to 99203. There is no lower new patient code, since 99201 was deleted.
What is the difference between 99202 and 99203?
Both are lower-level new patient visits. 99202 involves straightforward MDM, minimal problems, minimal data, and minimal risk, or 15 to 29 minutes. 99203 involves low MDM, such as one stable chronic illness or two minor problems, or 30 to 44 minutes. Defaulting to 99202 when the visit met 99203 is common undercoding.
Can 99202 be billed for telehealth?
Yes. 99202 can be billed for a telehealth new patient visit when it meets the same straightforward MDM or 15 to 29 minute requirement as an in-person visit. Append modifier 95 for audio-video and use the correct place of service. Confirm each payer’s telehealth and new-patient rules, since some limit new patient telehealth.
