Medicare data from 2023 shows CPT code 99202 appeared on more than 12 million claims. CMS audit findings reveal approximately 23% of those claims contained documentation or coding errors. That's a staggering volume of preventable revenue loss hitting practices of every size.
CPT code 99202 is an evaluation and management code for a new patient office or other outpatient visit requiring straightforward medical decision making or 15 to 29 minutes of total provider time on the encounter date. Getting any part of this wrong, whether it's the patient status, time threshold, or MDM level, puts your reimbursement at risk.
This guide covers every element of the 99202 CPT code for 2026: Medicare reimbursement rates, the dual conversion factor update, G2211 interaction rules, modifier guidance, straightforward MDM documentation standards, and denial prevention strategies. It's built for medical coders, billers, physicians, nurse practitioners, physician assistants, and practice administrators who need clear, current billing answers.
MedSole RCM is a full-service revenue cycle management company that helps providers bill E/M codes accurately and collect what they've earned. Everything in this guide reflects the compliance standards we apply across the practices we serve.
What Is CPT Code 99202?
CPT code 99202 is an evaluation and management (E/M) billing code used for an office or other outpatient visit involving a new patient. It requires either straightforward medical decision making or 15 to 29 minutes of total provider time on the encounter date. That's the core CPT code 99202 definition, and it drives how you document, code, and bill these encounters.
The code belongs to the Current Procedural Terminology system maintained by the American Medical Association (AMA). It sits within the Office or Other Outpatient Services code family (99202 to 99215) and is designated exclusively for new patients.
CMS adopted this classification for Medicare reimbursement under the evaluation and management framework, and nearly every commercial payer follows the same structure. You can verify the 99202 CPT code specifics through the AAPC codify database.
What is CPT code 99202 in practical terms? It's the code you report when a new patient presents with a straightforward clinical issue and the visit doesn't require complex workup, extensive testing, or significant resources.
Providers select CPT code 99202 through one of two pathways. The 2021 evaluation and management guideline overhaul by the AMA and CMS established this dual-pathway framework:
- Medical decision making pathway: The provider documents straightforward MDM, meeting the required threshold in at least two of three elements: problem complexity, data reviewed, and risk level.
- Total time pathway: The provider records 15 to 29 minutes of total time on the encounter date, covering both face-to-face and non-face-to-face work by the billing provider.
Only one pathway needs to be met and documented. The 99202 CPT code applies across primary care, mental health, chiropractic, dermatology, and other specialties. There's no restriction on which office visit CPT code a new patient encounter uses at this level, as long as documentation supports the selection.
99202 CPT Code Description
The official 99202 CPT code description, as published in the AMA CPT Professional Edition, reads:
"Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded."
Source: American Medical Association, CPT Professional Edition
In plain language, this CPT code 99202 description means the provider conducts a clinically relevant assessment and makes simple clinical decisions. No exhaustive workup is required. The documentation needs to reflect what's medically appropriate for the presenting complaint, not a comprehensive head-to-toe evaluation.
Here's some important context on how this 99202 CPT code description reached its current form. Before January 1, 2021, codes 99202 through 99205 required three distinct key components: history, examination, and medical decision making. Each component had its own levels that had to be met independently.
The 2021 revision eliminated those rigid requirements and introduced the current framework where providers choose between MDM level or total time. That change simplified code selection significantly for most practices.
On that same date, CMS and the AMA deleted CPT code 99201 because it shared the same straightforward MDM level as 99202. That redundancy made 99201 unnecessary, and 99202 became the lowest-level new patient evaluation and management code for office or outpatient visits.
Is CPT Code 99202 Still Valid in 2026?
Yes. CPT code 99202 is a valid, active code in 2026. The 2021 deletion of 99201 didn't affect 99202 in any way. Its descriptor, requirements, and reimbursement status remain completely unchanged. CMS continues to recognize it for Medicare payment, and no modifications are scheduled for upcoming code cycles.
Who Is a New Patient for CPT Code 99202?
The CMS and AMA define a new patient as someone who hasn't received any face-to-face professional services from the same physician, or another physician of the same specialty and subspecialty within the same group practice, within the previous three years.
That three-year window is everything. Get it wrong, and you're looking at denied claims and potential audit flags.
"Professional services" means face-to-face encounters billed under a specific CPT code. Phone calls don't count. Patient portal messages don't count. Scheduling interactions, prescription refills, and administrative contacts don't reset the clock either.
Here's where it gets tricky with group practices. In a multi-specialty group, a patient can be classified as new to one specialty even if they've seen a different specialty within the same organization. A patient who saw your group's cardiologist last month could still qualify as new to your group's dermatologist.
Single-specialty groups work differently. If any provider in the group saw that patient within three years, the patient is established for every provider in the group. No exceptions.
Let's say a patient last visited your practice's internal medicine provider in January 2023. In March 2026, they schedule a new appointment with the same provider. Because more than three years have passed, this patient qualifies as a new patient under CPT guidelines and you can bill CPT code 99202 if the visit meets the MDM or time criteria.
Misclassifying an established patient as new is one of the fastest ways to trigger a 99202 claim denial. Payers catch it quickly because they can cross-reference their own claims history. Before assigning any CPT code for new patient visits, verify patient status through your EHR records or past claims data. A 30-second check prevents a much bigger headache down the line.
CPT Code 99202 Time Requirements: What Counts in 2026
When selecting CPT code 99202 based on time, the provider must spend at least 15 minutes but less than 30 minutes of total time on the date of the encounter. Hit 30 minutes, and you're looking at 99203 territory. Under 15 minutes, don't bill 99202 at all.
The AMA E/M guidelines define "total time" as both face-to-face and non-face-to-face activities personally performed by the billing provider on the same calendar date. That distinction matters more than most people realize. It's not just the time spent in the room with the patient.
What Activities Count Toward Total Time?
These are the activities the billing provider can include in the 99202 time requirement calculation:
- Reviewing patient records, test results, and imaging before or after the visit
- Performing a medically appropriate history and/or 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 about the patient (when not separately billed)
- Independently interpreting results and communicating findings (when not separately billed)
What Does Not Count Toward Time?
Not everything that happens during an encounter day counts toward your 99202 time. Keep these out of your calculation:
- Time spent by nurses, medical assistants, or other clinical staff
- Travel time
- Time for services billed separately under their own CPT codes
- General administrative or scheduling tasks
- General teaching not related to the specific patient
How to Document Time for CPT Code 99202
Here's something most practices don't know: the AMA clarifies that providers aren't required to document time spent on each individual task. What you do need is the total time recorded with enough activity detail to survive an audit.
A compliant entry looks like this:
"Total clinician time on date of service: 22 minutes. Activities included reviewing outside records, face-to-face evaluation and examination, counseling patient on treatment plan, and documentation."
Compare that to what auditors actually see on a regular basis:
"Spent time with patient." [INSUFFICIENT: Vague, no total minutes, no activity description. Does not support time-based code selection.]
That second example won't hold up. It tells the auditor nothing verifiable about what the provider actually did or how long it took. When a payer questions your 99202 time, that note is all you have.
The table below shows how 99202 time fits within the full new patient E/M code range. If your documented time crosses into the next threshold and the clinical documentation supports it, bill the higher code.