CPT 99202: New Patient Office Visit, Straightforward
CPT 99202 reports a new patient office or outpatient visit with straightforward medical decision making or 15-29 minutes of total time. It is the entry-level new-patient E/M code. In 2026 Medicare pays about $75.15 non-facility (2.25 total RVUs times the $33.4009 conversion factor).
- Code type
- New patient E/M (office/outpatient)
- 2026 non-facility
- $75.15 (2.25 RVUs)
- 2026 facility
- $41.08 (1.23 RVUs)
- Time (if used)
- 15-29 minutes total on the date
What is CPT 99202 used for?
CPT 99202 is an office or other outpatient visit for a new patient that requires straightforward medical decision making or 15-29 minutes of total time on the date of the encounter. It is the lowest currently billable new-patient level, because 99201 was deleted in the 2021 E/M overhaul. Typical use is a single self-limited or minor problem, a rash, an uncomplicated upper-respiratory infection, a medication question, in someone your group and specialty has not seen in three years.
Since 2021 you select the level by MDM or by total time; history and exam no longer set the code but must remain medically appropriate to the presenting problem. A new patient is defined by the three-year rule: no face-to-face professional service from you, or from a physician of the exact same specialty and subspecialty in your group, within the prior three years. Miss that test and a genuine established patient gets billed as new, which reads as a clean overpayment on audit.
How much does 99202 pay in 2026?
99202 carries 2.25 total non-facility RVUs and 1.23 facility RVUs. At the 2026 conversion factor of $33.4009 that works out as follows:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility (office) | 2.25 | ~$75.15 |
| Facility | 1.23 | ~$41.08 |
The office rate is higher because the practice absorbs the staff and overhead that the practice-expense RVUs pay for. Medicare pays 80 percent of the allowed amount after the deductible; the patient or a secondary plan owes the remaining 20 percent coinsurance. Use the Medicare fee calculator for your locality's GPCI-adjusted amount, and expect commercial payers to run above the Medicare rate.
What documentation supports a 99202 instead of 99203?
Bill 99202 when the record shows straightforward decision making: one self-limited or minor problem, minimal or no data reviewed, and minimal risk. If the note documents two or more minor problems, a stable chronic condition, or any real data review such as labs or outside records, the visit likely meets low complexity and belongs at 99203, which pays about $42 more. The pivot is problem count, data, and risk, not the length of the history you gathered on a first encounter.
How does 99202 fit the new-patient family?
99202 is the floor of the new-patient ladder. Because a new-patient encounter usually involves building a full problem list from scratch, many visits legitimately meet low or moderate complexity and belong at 99203 or higher. Audit your new-patient distribution if 99202 dominates it.
Frequently asked questions
A new patient is one who has not received a professional face-to-face service from you, or another physician of the exact same specialty and subspecialty in your group, within the prior three years. If any provider in the group and specialty saw the patient in that window, use the established-patient codes (99211-99215) instead.
The 2026 national non-facility allowed amount is about $75.15 (2.25 total RVUs times the $33.4009 conversion factor). In a facility place of service it is about $41.08 (1.23 RVUs). Medicare pays 80 percent after the deductible; the patient or secondary owes the 20 percent coinsurance.
Both are new-patient visits. 99202 requires straightforward MDM (15-29 minutes); 99203 requires low MDM (30-44 minutes). The jump matters: 99203 pays about $42 more, so a note that supports low complexity but gets coded as straightforward gives away real revenue.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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