Choosing the right new patient CPT code comes down to three questions. Is the patient truly new? What level of medical decision making (MDM) does the note support? And how much time did the practitioner spend on the visit date? The office visit range runs from 99202 for straightforward MDM to 99205 for high MDM.
This guide explains each code in the 99202 to 99205 range, the three-year new patient rule, the current time thresholds and the mistakes that cause denials. It is written for physicians, coders and billing teams.
Quick answer: The new patient CPT code range for office and outpatient visits is 99202 to 99205. Select the level by MDM (straightforward, low, moderate or high) or by the practitioner’s total time on the visit date: at least 15, 30, 45 or 60 minutes. The patient must not have received professional services from your group, in the same specialty and subspecialty, in the past three years.
What Is the New Patient CPT Code Range?
The new patient CPT code range for office or other outpatient evaluation and management (E/M) visits is 99202 to 99205. Each code needs a medically appropriate history and/or exam. Then MDM or total time sets the level. In addition, 99201 no longer exists; CPT deleted it in 2021.
| CPT Code | MDM Level | Minimum Total Time | Typical Visit |
|---|---|---|---|
| 99202 | Straightforward | 15 minutes | One minor or self-limited problem |
| 99203 | Low | 30 minutes | One stable chronic illness or one acute uncomplicated problem |
| 99204 | Moderate | 45 minutes | Two or more stable chronic illnesses, or one that is worsening |
| 99205 | High | 60 minutes | Severe exacerbation or a threat to life or bodily function |
Since CPT 2024, these times are minimums that must be met or exceeded, not ranges. So the old “15 to 29 minutes” style ranges no longer apply. For example, a 50-minute visit meets the 99204 threshold, and a 65-minute visit meets 99205.
Who Qualifies for a New Patient CPT Code?
A patient is new when they have not received professional services in the past three years from the physician, or from another physician of the same specialty and subspecialty in the same group. As a result, a first visit with a particular doctor is not always a new patient visit.
For example, a patient saw Dr. A two years ago and now books a first visit with Dr. B in the same group. If both are in the same specialty and subspecialty, the patient is established. So the visit uses the established patient codes, 99211 to 99215, not a new patient CPT code.
| Category | New Patient | Established Patient |
|---|---|---|
| Office visit codes | 99202 to 99205 | 99211 to 99215 |
| Prior services | None from same specialty and group in 3 years | Services from same specialty and group in 3 years |
| Level selection | MDM or total time | MDM or total time |
| Main audit risk | Billing an established patient as new | Missing a higher supported level |
Payers watch this rule closely, because new patient codes pay more. For example, Medicare’s 2026 national office rate is $117.57 for 99203 and $95.19 for its established counterpart, 99213. You can check your locality rates in the CMS Physician Fee Schedule Look-up Tool.
How to Choose a New Patient CPT Code
Once you confirm new patient status, pick the level by MDM or by time, whichever the note better supports.
Selecting the Level by Medical Decision Making
MDM has three elements: the problems addressed, the data reviewed and analyzed, and the risk of patient management. The visit reaches a level when two of the three elements reach it. So a long note does not raise the level on its own. Instead, the note must show the problems, data and decisions that meet the level.
Selecting the Level by Total Time
Total time is the practitioner’s own time on the date of the visit, both face to face and not. It can include preparing, examining, counseling, ordering, documenting and coordinating care. However, it excludes time spent separately by clinical staff, time on separately billed services and work on another day. In addition, the note should state the total minutes.
Each New Patient CPT Code Explained
CPT Code 99202
99202 is the lowest new patient CPT code. It needs straightforward MDM or at least 15 minutes. A typical example is a new patient with one minor, self-limited problem, such as a simple rash.
CPT Code 99203
99203 needs low MDM or at least 30 minutes. It often fits a new patient with one stable chronic illness or one acute uncomplicated illness. Our CPT 99203 guide covers this level in detail.
CPT Code 99204
99204 needs moderate MDM or at least 45 minutes. For example, it fits a new patient with two stable chronic illnesses managed with prescription drugs, or one chronic illness that is getting worse. However, a diagnosis alone does not qualify a visit for 99204, so check each MDM element.
CPT Code 99205
99205 needs high MDM or at least 60 minutes. It fits complex visits, such as a severe exacerbation or a problem that threatens life or bodily function. Because it is the top level, auditors review it closely, so the note must clearly show the high-level work.
Prolonged Services After 99205
Long visits may support a prolonged service add-on. CPT uses 99417 for each 15 minutes beyond the 99205 minimum. Medicare instead uses G2212, which starts at 89 minutes of total time with 99205. So check each payer’s rule before you add either code.
Consult Codes vs the New Patient CPT Code
A referral does not turn a new patient visit into a consultation. Consultation codes need a request for an opinion from another provider and a written report back. In addition, Medicare does not pay consultation codes. So for Medicare patients, bill the new patient CPT code that fits the visit instead. Commercial plans vary, so check each payer’s policy.
Common New Patient CPT Code Mistakes
- Assuming every first visit is new: Check the three-year rule across the whole same-specialty group.
- Using 99201: The code was deleted in 2021, so claims with it will reject.
- Using old time ranges: Today’s times are minimums, not 15 to 29 minute style ranges.
- Coding from note length: A long note does not prove moderate or high MDM.
- Billing every referral as a consult: Medicare does not pay consult codes, and others have strict rules.
- Estimating time: Use the minutes actually documented, not the appointment slot.
A regular E/M coding audit shows whether your practice bills established patients as new or undercodes complex first visits.
Documentation Tips for New Patient Visits
- Note how you confirmed new patient status, such as a check of the group’s records.
- Name each problem addressed and its status.
- Record the data reviewed or ordered and the management decision.
- State the total time and what it covered when time sets the level.
- Make sure the level billed matches the note, not the payment you hope to get.
For the established patient side of the same rules, see our CPT 99213 guide.
The Bottom Line
The new patient CPT code range is 99202 to 99205, set by MDM or by total time of at least 15, 30, 45 or 60 minutes. Confirm new patient status first, use the current time thresholds and make sure the note supports the level billed. For hands-on help, our family and primary care billing services code new and established visits and follow every claim to payment.
