CPT Code 99202

Recent Medicare data reveals that CPT 99202 accounted for more than 12 million claims in 2023 alone making it one of the most widely used E/M codes for new patient visits. Yet, up to 23% of these claims faced documentation or coding errors according to CMS audit findings.

Why does this matter? Because payers are watching. Errors can trigger denials, recoupments, or even investigations. And with 2021 E/M guideline changes still causing confusion, every detail counts more than ever.

In this guide, we’ll break down exactly what CPT 99202 covers, how to document visits to meet requirements, and the practical steps to secure proper reimbursement. If you want to avoid

Definition of CPT 99202

CPT code 99202 is designated for office or other outpatient visits involving the evaluation and management of a new patient. This code applies when the provider conducts a medically appropriate history and/or examination and the medical decision-making (MDM) is of straightforward complexity.

Alternatively, the code can be selected based on total time spent on the date of the encounter, which should range between 15 and 29 minutes

Key Components of CPT 99202

Medical Decision Making (MDM): The MDM should be straightforward, involving minimal complexity in data review and risk assessment.

Time-Based Selection: If time is the determining factor, the total time spent by the provider on the date of the encounter should be between 15 and 29 minutes.

Documentation Requirements: The provider must document a medically appropriate history and/or examination, tailored to the patient's presenting problem(s).

99202 Billing Guidelines 

Billing CPT 99202 correctly means following precise rules set by CMS and commercial payers.  Here’s what you need to know to code and bill 99202 without errors.

1. Patient Status

• CPT 99202 applies only to new patients.

• A “new patient” is anyone who has not received any professional services from the same provider group in the last three years.

2. Medical Decision Making (MDM) or Time

• You can select 99202 based on straightforward MDM or total time spent.

• If using time, the provider’s total face-to-face and non-face-to-face time (on the day of the visit) must be at least 15 minutes but less than 30 minutes.

• Only count time spent by the billing provider. Don’t include staff or nurse time.

3. Documentation Requirements

• Document a medically appropriate history and/or examination.

• For MDM, record the problems addressed, the complexity of data reviewed, and the risk level.

• For time-based billing, record total time spent and all activities (e.g., reviewing records, ordering tests, counseling the patient).

4. Modifiers

• Use appropriate modifiers when billing with other services (for example, modifier -25 if a separate procedure or service was performed on the same day).

5. Payer-Specific Rules

• Some payers may have their own documentation checklists or requirements for 99202.

• Always check the latest payer policies and stay updated with any mid-year changes.

6. Telehealth and 99202

• For 2025, CMS continues to allow CPT 99202 for qualifying telehealth visits.

• Use the proper place of service code (typically POS 02 or POS 10) and modifier 95 for telehealth claims.

7. Common Denial Reasons

• Incomplete documentation

• Wrong patient status (not a new patient)

• Incorrect use of time versus MDM selection

What Counts and How to Document in 2025 - 99202 Time Requirement

In 2025, CMS and most major payers allow providers to select this code based on total time spent on the date of service, as long as certain criteria are met.

What Is the 99202 Time Range?

• Minimum: 15 minutes

• Maximum: 29 minutes

If the total time spent on the encounter is less than 15 minutes, you should not use CPT 99202. If it reaches 30 minutes, you must use a higher-level code, such as 99203.

What Activities Count Toward Total Time?

Only the time spent by the billing provider on the day of the patient’s encounter is eligible. This includes both face-to-face and non-face-to-face activities directly related to the visit.

Examples of billable activities:

• Preparing to see the patient (reviewing records, reports, labs)

• Performing a medically appropriate history and examination

• Counseling and educating the patient, family, or caregiver

• Ordering medications, tests, or procedures

• Documenting clinical information in the EHR

• Communicating with other healthcare professionals (when not separately billed)

• Interpreting and communicating results directly related to the patient’s problem

What does NOT count:

• Time spent by nurses or medical assistants

• Time spent on services billed separately (e.g., procedures)

• Unrelated administrative work

How to Document Time for CPT 99202

For compliance and audit protection, the provider should clearly record:

• The total time spent on the encounter rounded to the nearest minute (e.g., “Total time spent: 18 minutes”).

• A brief summary of activities performed, especially non-face-to-face work (e.g., “Reviewed outside lab results, provided counseling on new diagnosis, documented findings.”).

Example Documentation Statement:
“Total time spent on the date of the encounter: 22 minutes. Activities included reviewing past medical records, face-to-face evaluation and counseling, and documentation.”

Telehealth Visits and Time

For telehealth visits billed with 99202 in 2025, the time requirement is the same. Be sure to follow payer guidelines for telehealth documentation, including place of service and telehealth modifiers.

CPT 99202 Reimbursement Rates

For 2025, CMS and Medicare Administrative Contractors (MACs) have published updated rates that reflect the ongoing changes in the Physician Fee Schedule. These rates are not fixed nationwide; instead, they depend on geographic location and facility type.

Non-Facility vs. Facility Pricing

• Non-Facility Price: This is the amount paid when the service is performed in a physician’s office or similar non-facility setting.

• Facility Price: This rate applies when the service is provided in a hospital outpatient department or similar facility.

What the 2025 Data Shows

• In 2025, the non-facility price for CPT 99202 ranges from $63.52 (in locality 710213) up to $88.20 (in locality 111265).

• The facility price ranges from $42.38 (in locality 710213) to $60.45 (in locality 210201).

• The average reimbursement for most localities falls between $65 and $75 for non-facility, and $43 to $50 for facility.

HCPCS Code	Mac Locality	Non-Facility Price	Facility Price	Non-Facility Limiting Charge	Facility Limiting Charge
99202	0	$69.87	$45.29	$76.33	$49.47
99202	111205	$86.98	$52.10	$95.03	$56.92
99202	111209	$87.89	$52.61	$96.01	$57.47
99202	111251	$82.16	$49.96	$89.76	$54.58
99202	111252	$87.04	$52.15	$95.09	$56.98
99202	111253	$82.04	$49.84	$89.63	$54.45
99202	111254	$73.10	$46.23	$79.87	$50.51
99202	111255	$72.78	$45.91	$79.52	$50.16
99202	111256	$72.78	$45.91	$79.52	$50.16
99202	111257	$72.78	$45.91	$79.52	$50.16
99202	111258	$72.78	$45.91	$79.52	$50.16
99202	111259	$72.78	$45.91	$79.52	$50.16
99202	111260	$72.78	$45.91	$79.52	$50.16
99202	111261	$72.78	$45.91	$79.52	$50.16
99202	111262	$73.53	$46.67	$80.34	$50.98
99202	111263	$75.75	$47.33	$82.76	$51.71
99202	111264	$76.12	$47.48	$83.16	$51.87
99202	111265	$88.20	$52.93	$96.36	$57.82
99202	111266	$77.23	$47.50	$84.37	$51.90
99202	111267	$78.39	$48.10	$85.64	$52.55
99202	111268	$72.78	$45.91	$79.52	$50.16
99202	111269	$72.78	$45.91	$79.52	$50.16
99202	111270	$72.78	$45.91	$79.52	$50.16
99202	111275	$72.78	$45.91	$79.52	$50.16
99202	118217	$76.73	$47.64	$83.82	$52.05
99202	118218	$77.71	$48.36	$84.90	$52.83
99202	118271	$72.81	$45.94	$79.54	$50.18
99202	118272	$76.91	$47.63	$84.02	$52.04
99202	118273	$74.25	$46.42	$81.11	$50.71
99202	118274	$76.10	$47.21	$83.14	$51.58
99202	121201	$74.47	$46.22	$81.35	$50.49
99202	131200	$69.52	$44.93	$75.95	$49.09
99202	210201	$87.03	$60.45	$95.07	$66.04
99202	220200	$65.20	$42.87	$71.23	$46.84
99202	230201	$73.42	$46.30	$80.21	$50.59
99202	230299	$68.53	$44.30	$74.87	$48.39
99202	240202	$79.08	$49.09	$86.40	$53.63
99202	240299	$71.13	$45.57	$77.71	$49.78
99202	310200	$68.60	$44.63	$74.95	$48.76
99202	320201	$69.82	$45.24	$76.28	$49.42
99202	330201	$68.77	$44.19	$75.14	$48.28
99202	340202	$68.47	$43.89	$74.80	$47.95
99202	350209	$67.20	$44.26	$73.41	$48.35
99202	360221	$69.28	$44.69	$75.69	$48.83
99202	411201	$71.71	$45.82	$78.34	$50.06
99202	421205	$66.81	$44.48	$72.99	$48.60
99202	431200	$65.36	$43.45	$71.40	$47.47
99202	441209	$70.05	$45.32	$76.53	$49.51
99202	441211	$70.18	$45.43	$76.68	$49.63
99202	441215	$69.96	$45.38	$76.43	$49.58
99202	441218	$71.33	$46.67	$77.93	$50.99
99202	441220	$66.11	$43.91	$72.22	$47.97
99202	441228	$69.90	$45.37	$76.37	$49.56
99202	441231	$71.40	$45.69	$78.00	$49.91
99202	441299	$67.66	$44.42	$73.91	$48.53
99202	510200	$65.37	$42.93	$71.42	$46.90
99202	520200	$65.30	$43.03	$71.34	$47.01
99202	530201	$68.05	$44.65	$74.35	$48.78
99202	530202	$67.90	$44.59	$74.18	$48.72
99202	530299	$64.52	$43.40	$70.49	$47.42
99202	540200	$65.18	$42.64	$71.21	$46.58
99202	610212	$68.57	$46.00	$74.91	$50.25
99202	610215	$73.14	$47.38	$79.90	$51.76
99202	610216	$73.25	$48.10	$80.02	$52.55
99202	610299	$67.43	$45.01	$73.67	$49.17
99202	620200	$69.22	$44.02	$75.62	$48.10
99202	630200	$66.74	$43.21	$72.91	$47.21
99202	710213	$63.52	$42.38	$69.40	$46.30
99202	720201	$67.78	$44.80	$74.05	$48.94
99202	720299	$65.36	$43.70	$71.41	$47.75
99202	730200	$63.79	$42.84	$69.69	$46.81
99202	810200	$65.78	$43.11	$71.86	$47.10
99202	820201	$71.06	$46.82	$77.63	$51.15
99202	820299	$66.92	$44.53	$73.11	$48.64
99202	910203	$71.54	$47.00	$78.15	$51.35
99202	910204	$74.28	$49.03	$81.15	$53.57
99202	910299	$68.67	$45.57	$75.03	$49.78
99202	920220	$70.09	$45.33	$76.57	$49.53
99202	920250	$70.09	$45.33	$76.57	$49.53
99202	1011200	$63.99	$42.63	$69.91	$46.57
99202	1021201	$70.05	$45.54	$76.52	$49.75
99202	1021299	$65.76	$44.05	$71.84	$48.13
99202	1031235	$64.93	$42.91	$70.94	$46.88
99202	1120201	$66.19	$43.75	$72.31	$47.79
99202	1130200	$68.77	$44.58	$75.14	$48.71
99202	1140216	$65.44	$44.25	$71.50	$48.35
99202	1150200	$66.33	$43.57	$72.47	$47.60
99202	1210201	$69.72	$45.34	$76.17	$49.53
99202	1220201	$79.17	$49.86	$86.49	$54.48
99202	1230201	$74.10	$47.60	$80.95	$52.00
99202	1230299	$70.77	$45.79	$77.31	$50.03
99202	1240201	$78.32	$49.51	$85.56	$54.09
99202	1240299	$75.27	$48.08	$82.23	$52.52
99202	1250201	$72.98	$47.09	$79.73	$51.45
99202	1250299	$66.96	$44.17	$73.15	$48.26
99202	1310200	$74.41	$47.59	$81.30	$52.00
99202	1320201	$79.54	$50.87	$86.90	$55.58
99202	1320202	$81.39	$51.89	$88.92	$56.69
99202	1320203	$75.84	$48.65	$82.85	$53.15
99202	1328299	$67.35	$44.02	$73.58	$48.09
99202	1329204	$80.19	$50.81	$87.60	$55.51
99202	1411203	$69.54	$44.66	$75.97	$48.79
99202	1411299	$65.81	$43.37	$71.90	$47.38
99202	1421201	$78.28	$48.86	$85.52	$53.38
99202	1421299	$72.21	$46.12	$78.89	$50.39
99202	1431240	$70.91	$45.49	$77.47	$49.70
99202	1441201	$71.74	$46.20	$78.38	$50.47
99202	1451250	$68.51	$44.10	$74.85	$48.18
99202	1510200	$65.06	$43.50	$71.07	$47.52
99202	1520200	$66.60	$44.21	$72.76	$48.30

 

Modifiers for CPT 99202

For CPT 99202, modifiers clarify why service was provided and help avoid denials or unnecessary payer audits. Using the right modifier signals to payers that your billing accurately reflects the clinical scenario.

Most Common Modifiers with 99202

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service

• When to use: If you perform a separate E/M service (like 99202) on the same day as a procedure (for example, a minor surgery, injection, or other in-office procedure), use modifier 25 on 99202.

• Documentation tip: Clearly document how the E/M service was significant and separate from the procedure.

• Example: New patient comes in for a rash, and you also perform a cryotherapy procedure for warts. Report 99202-25 for the E/M, plus the procedure code.

Modifier 95: Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video

• When to use: When CPT 99202 is provided as a telehealth visit using real-time audio and video.

• Documentation tip: Note that the encounter was via telemedicine, including the technology used.

• Example: A new patient evaluation is completed over a HIPAA-compliant video call. Report 99202-95.

Modifier GT (less common): Via Interactive Audio and Video Telecommunications Systems

• When to use: Some payers or Medicaid plans may still require modifier GT for telehealth, though CMS now prefers modifier 95.

Modifier -57: Decision for Surgery

• When to use: Rarely needed with 99202, but use if the E/M service results in the initial decision to perform major surgery (90-day global).

• Example: New patient is evaluated and it is decided they need major surgery the same day—appendectomy, for example.

Other Situational Modifiers

• Modifier -GC: If a resident participates in the service under the supervision of a teaching physician, this modifier may be required.

• Place of Service (POS): For telehealth, also ensure the correct POS code (such as 02 or 10) is used with your modifier.

Avoid Unnecessary Modifiers

Do not add modifiers unless they are required by the encounter’s circumstances and payer policy. Unnecessary modifiers can delay claims or trigger audits.

Bottom Line

Proper coding and billing for CPT 99202 require more than a surface understanding of guidelines. With payers closely monitoring claims and documentation standards becoming more rigorous each year, especially in 2025, even minor errors can result in denials, delayed payments, or costly audits. Practices that take a meticulous approach—documenting each element, choosing the correct time or MDM basis, and applying the appropriate modifiers—are far better positioned for compliance and maximum reimbursement.

To further reduce risk and ensure ongoing accuracy, many healthcare providers are now turning to professional medical coding services for support. Working with a specialized partner like HMS USA LLC allows your team to focus on patient care, while experienced coders handle the complexities of billing regulations, payer requirements, and compliance updates. Investing in expert coding is not just about avoiding mistakes; it’s a strategic move to protect your practice’s revenue, reputation, and long-term growth.