CPT 99202E&M

Office o/p new sf 15 min

CPT code 99202 is used when a doctor sees a new patient in the office for a straightforward medical problem that requires 15-29 minutes of face-to-face time. This is the second level of five new patient office visit codes, designed for low complexity cases.

Showing rates for

National Average

Base Medicare rate

$69.87

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.93

PE RVU (NF)

1.16

MP RVU

0.07

Total RVU

2.16

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Use time-based coding for 99202 when 15-29 minutes of total time is spent on date of encounter, even if medical decision making seems minimal
Impact: Ensures appropriate level selection; prevents downcoding to deleted 99201 or incorrect upcoding to 99203 ($109.14), avoiding $39.27 overpayment risk
Verify new patient status (no professional service from same physician/specialty in past 3 years); billing established code 99212 incorrectly loses $27.78 in revenue
Impact: 99202 pays $69.87 vs 99212 at approximately $42.09; ensures maximum appropriate reimbursement of additional $27.78
Accurately report place of service: POS 11 (office) triggers $69.87 non-facility rate vs POS 22 (hospital outpatient) at $45.29 facility rate
Impact: Incorrect POS coding results in $24.58 underpayment when office services are billed with hospital POS codes
Document total time precisely when using time-based selection; 14 minutes may require 99201 consideration (deleted) or risk downcoding; 30+ minutes supports 99203
Impact: One minute difference (14 vs 15) can impact coding defensibility; exceeding 29 minutes justifies 99203 worth additional $39.27
Bundle routine preventive services separately; if new patient presents for physical, use 99385-99387 series, not 99202 plus preventive code
Impact: Prevents bundling denials and ensures correct payment structure; preventive codes pay differently than problem-oriented E/M
For non-facility settings, ensure practice absorbs overhead costs factored into the 1.16 non-facility PE RVU worth $37.52 of the total payment
Understanding the $24.58 PE RVU differential helps justify overhead expenses and place-of-service financial decisions

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 99202 in 2025?

Medicare pays $69.87 for 99202 in non-facility settings and $45.29 in facility settings based on the 2025 Medicare Physician Fee Schedule. The rate difference of $24.58 reflects the practice expense costs absorbed by non-facility settings.

How many minutes are required for CPT code 99202?

CPT 99202 requires 15-29 minutes of total time spent by the physician or qualified healthcare professional on the date of encounter. This includes face-to-face time plus time spent reviewing records, ordering tests, and documenting. Less than 15 minutes may not support 99202, while 30+ minutes supports 99203.

What is the difference between 99202 and 99203?

99202 requires straightforward medical decision making or 15-29 minutes of time, while 99203 requires low complexity MDM or 30-44 minutes. Medicare pays $69.87 for 99202 versus $109.14 for 99203 (non-facility), a difference of $39.27, making proper level selection financially significant.

Can I bill 99202 for a telehealth visit?

Yes, 99202 can be billed for telehealth visits when permitted by payer policy and regulations. Append modifier 95 or GT as required by the payer, and ensure the service meets the same time or medical decision making requirements as in-person visits. Payment rates for telehealth may vary by payer and current policy.

What are the RVUs for CPT code 99202?

CPT 99202 has a total of 2.16 RVUs in 2025: 0.93 work RVU, 1.16 practice expense RVU (non-facility), 0.4 PE RVU (facility), and 0.07 malpractice RVU. When multiplied by the 2025 conversion factor of 32.3465, this yields the Medicare payment rates.

How do I determine if a patient is new or established for 99202 billing?

A patient is considered new if they have not received any professional services from the physician or another physician of the same specialty in the same group practice within the past 3 years. If seen within 3 years, use established patient codes 99211-99215 instead of 99202. This is a common audit point.

Can I bill 99202 with a procedure on the same day?

Yes, but you must append modifier 25 to the 99202 code to indicate a significant, separately identifiable E/M service was performed on the same day as a minor procedure. Documentation must clearly show the E/M was beyond the usual pre- and post-operative work of the procedure, or the claim will be denied or bundled.