CPT Code 99202: New Patient Office Visit, 15-29 Minutes

CPT code 99202 reports the lowest-level office or outpatient E/M visit for a new patient, requiring straightforward medical decision-making. 

It applies exclusively to patients who have not received professional services from the same physician or same-specialty group within the past three years. 

Providers select 99202 through either straightforward MDM (two of three elements) or 15-29 minutes of qualifying physician time on the date of service.

99202 replaced the former 99201 (which was deleted effective January 2021) and now serves as the entry point for billable new-patient office E/M. 

CMS’s automated Recovery Audit for incorrect new-patient coding covers 99202-99205 — and the most common compliance failure at the 99202 level is billing a new-patient code when the patient actually qualifies as established under the three-year/same-specialty rule.

What does CPT code 99202 cover?

The essential reference facts for 99202 billing.

Detail	CPT 99202
Description	New patient office visit, 15-29 minutes
Category	Evaluation and Management (E/M)
Patient type	New only
MDM level	Straightforward
Time	15-29 total physician/QHP minutes
Common modifiers	25, 95, 93
Medicare rate	~$68.20 non-facility / ~$47.70 facility (2026)
Commonly compared with	CPT 99203

A typical 99202 encounter involves a new patient presenting with a single self-limited or minor problem — a rash, an insect bite, a straightforward wart evaluation — where no prescription management, no diagnostic complexity, and no treatment risk is involved beyond the minimal.

When should you use CPT 99202?

Two gates must be cleared — the patient must genuinely qualify as new, and the clinical work must stay at the straightforward level.

Use CPT 99202 when

• The patient has not received professional services from the physician or same-specialty group in the past three years
• At least two of three MDM elements meet the straightforward level
• Or the provider spends 15-29 qualifying minutes on the date of service
• The visit addresses a self-limited or minor problem requiring no prescription management, no diagnostic workup, and no meaningful clinical uncertainty

When not to use it

• The patient was seen by any same-specialty physician in the same group within three years — use established-patient 99212 instead
• A chronic illness is actively managed or a prescription is written — the encounter rises to low MDM (99203)
• Total qualifying time reaches 30+ minutes — use 99203
• The clinical work is entirely absent — if no medically necessary E/M service occurred, no E/M code is appropriate

How is CPT 99202 selected?

Two independent pathways support 99202. A provider does not need both.

MDM pathway

At least two of these three elements must meet straightforward per the AMA MDM grid.

MDM element	Straightforward threshold
Problems addressed	1 self-limited or minor problem
Data reviewed	Minimal or none
Risk	Minimal risk of morbidity from testing or treatment

Straightforward is the floor for new patients. If any element rises above minimal — a stable chronic condition, any test ordered, or any prescription managed — the MDM reaches low, and 99203 becomes the correct code.

Time pathway

If 15-29 total physician/QHP minutes are spent on the date of service, 99202 is independently supported. The 15-minute floor is the lowest time threshold in the new-patient family (established 99212 starts at 10 minutes).

What documentation supports CPT 99202?

For a straightforward new-patient visit, the documentation requirement is proportionally light — but the note must still establish both new-patient status and a medically necessary encounter.

The note should include

• Assessment and plan
• Medical necessity for the visit
• The problem addressed (even a minor problem needs identification)
• Why the patient qualifies as new (first visit, or no same-specialty/group services in 3 years)

When billing by time, record actual total minutes. If MDM supports 99202, no time documentation is required. CMS emphasizes that documentation volume does not determine the code level — the clinical work does.

How much does CPT 99202 reimburse?

The lowest new-patient E/M payment — but still meaningfully higher than its established-patient counterpart (99212).

Payment type	2026 rate
Medicare non-facility (national baseline)	~$68.20
Medicare facility (national baseline)	~$47.70
Commercial payers (median observed)	~$65-$75
Medicaid	Varies by state

Medicare rates from CMS 2026 PFS national baselines (0.93 work RVU).

The $20 gap between non-facility and facility rates follows the standard overhead-allocation pattern. 

New-patient codes always reimburse higher than the corresponding established-patient level because the initial encounter involves greater work — history gathering, comprehensive intake, and establishing the care relationship.

Which modifiers apply to CPT 99202?

Modifier	When it applies
25	Significant, separately identifiable E/M same day as a procedure — rare at the straightforward level
95	Synchronous audio-video telehealth
93	Audio-only telehealth (qualifying services through 12/31/2027)

Modifier 25 at the 99202 level is inherently unusual. 

A straightforward-MDM encounter paired with a same-day procedure raises the question of whether the E/M is genuinely separate — OIG has targeted same-day E/M patterns that lack documentation of separately identifiable clinical work.

CPT 99202 vs. 99203 — which one fits?

Both cover new patients. The boundary separates straightforward from low MDM.

Feature	CPT 99202	CPT 99203
Patient type	New	New
MDM level	Straightforward	Low
Time	15-29 minutes	30-44 minutes
Typical use	Self-limited problem, no Rx, no testing	1 stable chronic condition, uncomplicated acute, minor Rx
Medicare rate (2026)	~$68.20	~$117.57
Work RVU	0.93	1.60

Choose 99202 when the encounter involves only a self-limited/minor problem with minimal data and minimal risk — no chronic disease management and no prescription decisions.

Choose 99203 when a chronic condition is managed, an acute problem requires evaluation beyond the self-limited level, or any prescription management occurs.

The practical dividing line matches the 99212/99213 boundary — if a prescription is written or a chronic condition is actively managed, the visit has moved past straightforward. The difference is that 99202 applies to new patients while 99212 applies to established ones.

What billing errors should you avoid with CPT 99202?

Four errors account for the most common 99202 compliance issues.

1. Billing 99202 for an established patient 

CMS’s Recovery Audit targets incorrect new-patient coding. Verify the three-year/same-specialty history before selecting any 992XX code. A patient new to the individual physician but seen by another provider in the same group specialty within three years is established.

2. Upcoding to 99203 when MDM is truly straightforward 

A single self-limited problem with no data review and no treatment risk is straightforward — not low. Billing 99203 for a minor wart evaluation with no prescription or test overstates the complexity.

3. Downgrading a 99203-level visit to 99202 

The opposite error. If a chronic condition was managed or a prescription written, 99203 is the minimum code. Under-billing costs revenue and does not protect against audit — auditors review in both directions.

4. Automatically attaching modifier 25 with same-day procedures 

A straightforward MDM encounter paired with a minor procedure is extremely unlikely to represent separately identifiable E/M work. The routine evaluation leading to a minor procedure is included in the procedure payment.

Frequently asked questions about CPT 99202

Here are some commonly asked questions about this topic: