Choosing the correct New Patient CPT code range can be difficult when a provider must distinguish among 99202, 99203, 99204, and 99205. Since the office/outpatient E/M revisions took effect on January 1, 2021, code selection has focused on medical decision making (MDM) or total time rather than using history and examination as the primary level-selection elements.
The 99202–99205 range remains central to Medicare office/outpatient E/M billing in 2026. AMA’s current resources identify 99203 with low-level MDM or 30–44 minutes when time is used, while 99204 uses moderate-level MDM or 45–59 minutes. Accurate selection can support cleaner claims, while unsupported code levels, incorrect patient status, or incomplete time documentation can create billing and compliance problems. CMS also identifies new-patient visit coding as an area subject to Medicare review.
This guide explains CPT 99202–99205, including MDM levels, time requirements, new-patient status, documentation, and common coding errors.
What Is the New Patient CPT Code Range?
The New Patient CPT code range for office or other outpatient E/M services is 99202–99205. The four codes represent increasing levels of service and can be selected using either medical decision making (MDM) or total time on the date of the encounter.
CPT Code Range 99202–99205 at a Glance
| CPT Code | MDM Level | Total Time When Time Is Used |
| 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 to select the office/outpatient E/M level. The provider does not need to meet both the listed MDM level and time range. CMS states that office/outpatient E/M levels can be reported based on either revised MDM or the practitioner’s total time on the date of the visit.
Why CPT 99201 Is No Longer in the New Patient Range
CPT 99201 was deleted effective January 1, 2021. The change reduced the new-patient office/outpatient E/M category from five levels to four. As a result, 99202 became the lowest new-patient office/outpatient E/M code.
The 2021 revisions also changed how providers select the E/M level. History and examination are still performed when medically appropriate, but they are no longer used as the primary elements for choosing the level. Instead, providers use MDM or total time.
This change matters for coders and billers reviewing older documentation. A pre-2021 reference that includes 99201 or relies on the former history-and-examination leveling method may not reflect the current coding framework.
What Qualifies as a New Patient for CPT Coding?
A patient’s “new” status is based on prior professional services, not simply on whether the patient is visiting a new office or presenting with a new condition. The correct status determines whether the 99202–99205 or established-patient E/M family applies.
The 3-Year New Patient Rule
Under CPT guidance, a new patient is someone who has not received professional services from the physician or other qualified healthcare professional, or another clinician of the same specialty and subspecialty in the same group practice, within the previous three years.
For example, if a patient last received a qualifying service from the same specialty three years ago, a new-patient evaluation may be appropriate. However, simply having no recent office visit does not always establish new-patient status. CMS also notes that certain diagnostic interpretations without an E/M or other face-to-face service do not by themselves change the patient’s status.
Same Specialty and Same Group Practice
The same specialty and group practice test matters. A patient may have seen a physician in a different specialty within the same group and still qualify as new to another specialty, depending on the circumstances. AMA guidance also explains that physicians and qualified professionals working within the same specialty and subspecialty of a group are considered when determining patient status.
For Medicare billing, CMS states that the prior professional service can include an E/M service or another face-to-face professional service from the physician or physician group of the same specialty during the three years.
New Patient vs. Established Patient
| Patient status | General CPT rule | Common office/outpatient codes |
| New patient | No qualifying professional service from the same physician or applicable same-specialty clinician in the same group during the previous 3 years | 99202–99205 |
| Established patient | Qualifying professional service occurred within the previous 3 years | 99211–99215 |
CPT Code 99202 Description and When to Use It
CPT 99202 is the lowest code in the current new-patient office/outpatient E/M range. It applies when the encounter supports straightforward MDM or 15–29 minutes of total physician/QHP time on the date of service.
CPT 99202 MDM Level
For MDM-based selection, 99202 represents straightforward MDM. The MDM framework considers three elements:
Problems: One self-limited or minor problem
Data: Minimal or no data reviewed or analyzed
Risk: Minimal risk from additional diagnostic testing or treatment
CPT Code 99204 Time Requirement
When using the time method, 45–59 minutes of total physician or other qualified healthcare professional time must be spent on the date of service. Qualifying work can include activities performed before, during, and after the patient encounter on that date.
The time method and MDM method are separate options. A provider does not need both 45–59 minutes and moderate MDM to report 99204. The documentation should support whichever method is used.
Medical Code 99204: Practical Example
A new patient presents with multiple chronic conditions that require evaluation and management. The clinician reviews relevant records and test results, assesses the conditions, and makes treatment decisions involving moderate risk. If two of the three MDM elements meet the moderate level, 99204 may be supported, even if the encounter does not reach 45 minutes.
99204 vs. 99203
| Factor | 99203 | 99204 |
| MDM | Low | Moderate |
| Time when used | 30–44 minutes | 45–59 minutes |
| Service level | Lower | Higher |
| MDM threshold | Low | Moderate |
CPT Code 99205 Description and When to Use It
CPT 99205 is the highest level in the new-patient office or other outpatient E/M range. It applies when the encounter supports high-level medical decision-making (MDM) or, when time is used, at least 60 minutes of total time on the date of service.
CPT Code 99205 MDM Level
For MDM-based coding, 99205 requires high-level MDM. The assessment considers:
Problems addressed: High-severity problems, such as an illness or injury that may threaten life or bodily function.
Data reviewed and analyzed: Extensive review or analysis of records, tests, or other clinical information.
Risk: High risk associated with patient management, treatment, or diagnostic decisions.
CPT Code 99205 Time Requirement
When total time is used for code selection, the current CPT framework uses a 60-minute threshold for 99205. The documented time can include qualifying work performed on the date of the encounter, including applicable activities before and after direct patient contact. AMA explains that the CPT Editorial Panel changed 99205 from a 60–74-minute range to a 60-minute threshold that must be met or exceeded.
For Medicare, CMS provides additional guidance for prolonged office/outpatient services. Its claims-processing instructions list 99205 at 60–74 minutes and allow G2212 when the total time reaches the applicable prolonged-service threshold.
99205 vs. 99204
| Factor | 99204 | 99205 |
| MDM | Moderate | High |
| Time method | 45 minutes or more* | 60 minutes or more* |
| Service level | Higher | Highest new-patient level |
| Typical MDM concern | Moderate management risk | High management risk |
*Current CPT uses time thresholds; Medicare’s prolonged-service guidance separately uses 60–74 minutes as the base 99205 interval for reporting G2212.
The key distinction is the level of MDM or supported total time, rather than the perceived seriousness of the patient’s diagnosis alone. This distinction helps prevent routine use of 99205 simply because a case is clinically challenging.
How to Choose the Correct New Patient CPT Code
Selecting the correct new-patient E/M code requires more than checking how long the visit lasted. For office and outpatient services, the level can generally be selected using medical decision making (MDM) or total time, with documentation supporting the method used.
H3: Select the Code by Medical Decision Making
MDM evaluates three elements:
1. Problems addressed: the number and complexity of conditions managed.
2. Data reviewed and analyzed: records, tests, independent interpretations, and discussions with other healthcare professionals.
3. Risk of patient management: risks linked to treatment, testing, or management decisions.
For office/outpatient E/M services, the selected MDM level is generally based on meeting the required level for 2 of these 3 elements.
A simple guide is:
99202: Straightforward MDM
99203: Low MDM
99204: Moderate MDM
99205: High MDM
The diagnosis itself does not automatically determine the code. The documented work and management decisions must support the reported level.
Select the Code by Total Time
Time can be used instead of MDM when it better represents the service. For 2026, AMA’s E/M guidance lists these time ranges:
99202: 15–29 minutes
99203: 30–44 minutes
99204: 45–59 minutes
99205: 60–74 minutes
The time method includes qualifying physician or QHP work performed on the date of service, not just face-to-face time. This can include preparation, reviewing information, counseling, ordering services, documentation, and care coordination when applicable.
What If MDM and Time Point to Different Levels?
The two methods do not have to produce the same code. For example, a complex encounter could support 99204 through MDM even if the provider spent less than 45 minutes on it. Conversely, a time-intensive encounter may support a higher level through documented total time even when the MDM level is lower.
Conclusion
Understanding the New Patient CPT code range 99202–99205 helps providers, coders, and billers select the appropriate E/M level based on documented MDM or total time. Accurate patient-status verification and current coding guidance also help reduce avoidable billing and compliance issues.
Review the encounter details, confirm new-patient status, and select the code that the documentation supports. Applying the correct method consistently can support accurate claims and appropriate reimbursement.
FAQs
What is the New Patient CPT code range?
The current New Patient CPT code range for office or other outpatient E/M services is 99202–99205. The appropriate code is selected based on medical decision making (MDM) or total time, depending on the method used.
What is the difference between CPT 99202, 99203, 99204, and 99205?
The codes represent increasing levels of new-patient E/M service. They correspond to straightforward, low, moderate, and high MDM, respectively. When time is used, the applicable ranges are 15–29, 30–44, 45–59, and 60–74 minutes.
What is the 99203 time requirement?
When selecting CPT 99203 by time, the physician or qualified healthcare professional must document 30–44 minutes of total time on the date of the encounter. Time-based selection is separate from MDM-based selection.
How do I determine whether a patient is new or established?
Generally, a patient is considered new if they have not received qualifying professional services from the physician or another physician or QHP of the same specialty and subspecialty in the same group practice within the previous three years. Established-patient codes generally include 99211–99215.
Is CPT 99201 still used for new-patient office visits?
No. CPT 99201 was deleted effective January 1, 2021. The current new-patient office/outpatient E/M range begins with 99202 and ends with 99205.
