Choosing the right new patient CPT code can be challenging when the difference between 99202, 99203, 99204, and 99205 comes down to medical decision making (MDM), total time, and the documentation supporting the encounter. The new patient CPT code range 99202-99205 covers office and other outpatient E/M visits, progressing from straightforward MDM with CPT code 99202 to high MDM with CPT code 99205. When coding by total time, these services range from 15-29 minutes for 99202 to 60-74 minutes for 99205.
Exploring these differences helps healthcare providers and billing teams select the appropriate new patient office visit CPT code, strengthen documentation, reduce coding errors, and support accurate reimbursement.
In this guide, we’ll break down each code, its description, time requirements, MDM level, and key differences so you can determine which code best fits the patient encounter.
What Is the New Patient CPT Code Range?
The new patient CPT code range is 99202-99205 for office or other outpatient Evaluation and Management (E/M) services. These codes represent different levels of service based primarily on medical decision-making (MDM) or, when time is used to select the code, the total qualifying time spent by the physician or other qualified healthcare professional on the date of the encounter.
The range begins with CPT code 99202 for straightforward MDM and progresses to CPT code 99205 for high-level MDM. CPT 99201 is no longer part of the active new-patient office/outpatient E/M range because it was deleted as part of the 2021 E/M changes.
Here is a quick overview of the CPT code range 99202-99205:
| CPT Code | MDM Level | Total Time When Coding by Time |
| 99202 | Straightforward | 15-29 minutes |
| 99203 | Low | 30-44 minutes |
| 99204 | Moderate | 45-59 minutes |
| 99205 | High | 60-74 minutes |
These time ranges apply when total time is used for code selection. The appropriate code should always be supported by the documentation and applicable coding and payer requirements. CMS recognizes 99202-99205 as the office/outpatient E/M base-code family for new patients.
What Qualifies as a New Patient for CPT Coding?
Before deciding whether to use 99202, 99203, 99204, or 99205, you first need to determine whether the individual actually qualifies as a new patient.
Under CPT guidance, a new patient generally has not received professional services during the previous three years from the physician or qualified healthcare professional, or another physician or qualified healthcare professional of the same specialty and subspecialty who belongs to the same group practice.
This distinction is important because a patient does not automatically become “new” simply because it is their first appointment with a particular provider.
For example, suppose a patient saw Dr. A within a group practice two years ago and now schedules their first appointment with Dr. B in that same group. If both physicians practice the same specialty and subspecialty, the patient’s first appointment with Dr. B would not necessarily qualify as a new-patient encounter.
Incorrectly classifying established patients as new patients can create coding and reimbursement problems. In fact, CMS has specifically identified incorrect coding of new-patient visits as a compliance issue.
New Patient vs. Established Patient
The distinction can be summarized as follows:
| Category | New Patient | Established Patient |
| Office/outpatient CPT range | 99202-99205 | 99211-99215 |
| Patient relationship | Meets applicable new-patient criteria | Has received qualifying professional services within the applicable three-year period |
| Code selection | MDM or total time, as applicable | MDM or total time, as applicable |
| Main concern | Correctly establishing new-patient status | Correctly identifying prior professional services |
CMS currently recognizes both 99202-99205 and 99211-99215 as office/outpatient E/M base codes.
How to Choose Between CPT Codes 99202, 99203, 99204, and 99205
Once you determine that the encounter qualifies as a new-patient office/outpatient visit, the next question is which code to select.
For these E/M services, code selection can generally be based on medical decision making or total time on the date of the encounter.
Code Selection Based on Medical Decision Making
MDM reflects the complexity of evaluating and managing the patient’s medical care.
For the new-patient office/outpatient range, the progression is:
- 99202: Straightforward MDM
- 99203: Low MDM
- 99204: Moderate MDM
- 99205: High MDM
MDM considers three major elements:
- The number and complexity of problems addressed
- The amount and/or complexity of data reviewed and analyzed
- The risk of complications and/or morbidity or mortality associated with patient management
This means that a longer note does not automatically justify a higher CPT code. The documented encounter must support the applicable MDM requirements.
Code Selection Based on Total Time
Providers may instead select the appropriate office/outpatient E/M code based on qualifying total time on the date of the encounter.
The progression is easy to remember:
15-29 minutes → 99202
30-44 minutes → 99203
45-59 minutes → 99204
60-74 minutes → 99205
When selecting a code based on time, proper documentation of qualifying time is essential. CMS’s prolonged-service guidance confirms the 60-74 minute base range for 99205 and explains that total time can include qualifying practitioner work with and without direct patient contact on the date of service.
CPT Code 99202: Description, Requirements, and Time
CPT code 99202 is used for an eligible new-patient office or other outpatient E/M encounter at the straightforward MDM level.
It is the lowest-level code currently available within the standard new patient CPT code range 99202-99205.
CPT Code 99202 Description
In practical terms, the CPT code 99202 description refers to a new-patient office/outpatient E/M service involving a medically appropriate history and/or examination and straightforward medical decision-making.
The exact amount of history or physical examination performed does not, by itself, determine whether 99202 should be selected.
CPT 99202 Time Requirement
When selecting the code based on total time, 99202 corresponds to 15-29 minutes on the date of the encounter.
For example, a relatively uncomplicated new-patient encounter requiring limited evaluation and straightforward management may potentially support 99202 when all applicable requirements are satisfied.
CPT Code 99203: Description, Requirements, and Time
CPT code 99203, sometimes searched as medical code 99203, represents a new-patient office or outpatient E/M service with low medical decision-making when MDM is the basis for code selection.
It represents a step up in complexity from CPT 99202.
CPT Code 99203 Description
The CPT code 99203 description, in practical terms, covers an eligible new-patient office/outpatient E/M encounter involving a medically appropriate history and/or examination with low-level MDM.
The difference between 99202 and 99203 is therefore not simply whether the physician spent a few extra minutes with the patient. If MDM determines the code, the documented level of decision-making must support the selection.
99203 Time Requirement
The 99203 time requirement is 30-44 minutes when the code is selected based on total time.
A provider spending 35 minutes performing qualifying activities for an eligible new-patient encounter, for example, could potentially select 99203 based on time when the documentation and other applicable requirements support it.
CPT Code 99204: Description, Requirements, and Time
CPT code 99204, also referred to in searches as medical code 99204, represents a new-patient office/outpatient E/M service involving moderate medical decision-making when MDM is used to select the code.
Because moderate MDM can involve more significant clinical decision making than 99203, documentation becomes especially important.
99204 CPT Code Description
The 99204 CPT code description, explained in plain language, involves an eligible new-patient office or outpatient E/M encounter with a medically appropriate history and/or examination and moderate MDM.
Depending on the encounter, moderate MDM may be associated with greater problem complexity, more extensive data considerations, or greater patient-management risk. However, coders should assess the applicable MDM criteria rather than assuming that a particular diagnosis automatically qualifies for 99204.
CPT 99204 Time Requirement
When selecting the code based on total time, CPT 99204 corresponds to 45-59 minutes.
For instance, if a physician spends 50 minutes on qualifying activities for a new patient’s care on the encounter date, 99204 may potentially be selected based on time when properly documented.
CPT Code 99205: Description, Requirements, and Time
CPT code 99205 is the highest-level standard office/outpatient E/M code within the new patient CPT code range.
When MDM is used for selection, it represents high medical decision-making.
CPT Code 99205 Description
In practical terms, the CPT code 99205 description covers an eligible new-patient office/outpatient E/M encounter requiring a medically appropriate history and/or examination and high-level MDM.
Because 99205 represents the highest level in this new-patient code family, documentation should clearly support the complexity of the service when MDM is used.
What Is the 99205 Time Requirement?
The 99205 time range is 60-74 minutes when the service is selected based on total time.
CMS guidance specifically identifies 60-74 minutes as the base time range for 99205 in its prolonged office/outpatient E/M reporting framework.
Services extending beyond the base time associated with 99205 may involve prolonged-service coding. However, prolonged-service requirements can differ between Medicare and other payers, so providers should verify the applicable rules rather than assuming that every encounter exceeding 74 minutes can be billed the same way.
What Is the CPT Code for a New Patient Office Visit?
There is no single new patient office visit CPT code that applies to every encounter.
For qualifying new-patient office or other outpatient E/M visits, providers generally select from:
99202, 99203, 99204, or 99205.
The correct code depends on the documented MDM level or qualifying total time, as applicable.
A simple way to think about the process is:
Confirm new-patient status → Confirm office/outpatient E/M service → Determine MDM or qualifying total time → Select the supported code from 99202-99205
Correctly identifying the patient’s status should come first. CMS has specifically included 99202-99205 among the codes affected by reviews of incorrectly reported new-patient visits.
New Patient Consult CPT Code vs. New Patient Office Visit Code
Another common source of confusion involves the new patient consult CPT code.
A consultation and a new-patient office visit are not automatically the same thing. Likewise, receiving a referral does not necessarily mean that the encounter should be billed using a consultation code.
Payer policy is particularly important here.
Providers should determine whether the service satisfies applicable consultation requirements and whether the patient’s payer recognizes consultation codes. When consultation requirements or payer policies do not support consultation billing, the appropriate office/outpatient E/M code may need to be reported instead.
For Medicare billing in particular, current payer requirements should always be verified before submitting the claim.
The key takeaway is simple: do not choose a consultation code solely because another healthcare professional referred the patient.
New Patient CPT Codes vs. Established Patient CPT Codes
A new patient CPT code and an established patient CPT code should not be selected solely based on how familiar the provider is with the patient.
For office/outpatient E/M services, the primary ranges are:
| Patient Status | CPT Code Range |
| New patient | 99202-99205 |
| Established patient | 99211-99215 |
CMS recognizes both ranges as office/outpatient E/M base services.
The important distinction is the patient’s professional-service history under applicable new-versus-established patient rules.
A patient seeing a particular physician for the first time may still qualify as established if they previously received professional services from another physician or qualified healthcare professional of the same specialty and subspecialty in the same group within the applicable three-year period.
Common Mistakes When Coding New Patient Visits
Even when the CPT code range 99202-99205 seems straightforward, small mistakes can lead to inaccurate coding, claim issues, or compliance concerns.
1. Assuming Every First Appointment Is a New Patient Visit:
A patient’s first visit with one individual physician does not automatically establish new-patient status. Always consider prior professional services, specialty/subspecialty, group practice, and the applicable three-year rule.
2. Using CPT Code 99201:
CPT 99201 was deleted as part of the office/outpatient E/M changes. The current new-patient office/outpatient E/M range begins with 99202.
3. Selecting the Code From Note Length:
A long clinical note does not automatically support 99204 or 99205.
Documentation should accurately demonstrate the MDM or total time used to select the code.
4. Confusing 99203 With 99204:
When using MDM, 99203 represents low MDM, while 99204 represents moderate MDM. When using time, their ranges are 30-44 minutes and 45-59 minutes, respectively.
5. Treating Every Referral as a Consultation:
A referral alone should not determine whether consultation coding is appropriate. Consultation requirements and payer-specific policies need to be considered.
6. Failing to Document Time Properly:
If total time determines the E/M level, the record should support the qualifying time used for code selection. Do not simply estimate or automatically assign a code from the scheduled appointment duration.
Documentation Tips for CPT Codes 99202-99205
Accurate documentation helps demonstrate why a particular new patient CPT code was selected and can reduce avoidable coding disputes.
Healthcare organizations and coding teams should consider these practices:
- Clearly document the problems evaluated and addressed during the encounter.
- Record clinically relevant data reviewed and analyzed.
- Document management decisions and associated patient-management risk.
- Record qualifying total time when using time to select the E/M level.
- Make sure documentation supports the level actually billed.
- Do not assume that extensive history or examination documentation automatically increases the E/M level.
- Check payer-specific requirements when necessary.
Most importantly, coding should reflect the service actually performed and documented rather than the reimbursement associated with a particular code.
Final Thoughts
Remember the basic progression: CPT code 99202 represents straightforward MDM, 99203 represents low MDM, 99204 represents moderate MDM, and 99205 represents high MDM. When coding by time, their respective ranges are 15-29, 30-44, 45-59, and 60-74 minutes.
But selecting the correct code involves more than memorizing numbers. Providers and billing teams must first confirm whether the individual qualifies as a new patient, determine the appropriate method for selecting the E/M level, and ensure the documentation supports the service reported. Payer-specific requirements should also be reviewed whenever they may affect billing.
