What is the procedure code for new patient office visit?
Asked by: Garrick Dooley | Last update: July 21, 2025Score: 4.6/5 (2 votes)
What is the CPT code for a new patient office visit?
To report, use 99202. Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making.
What is the difference between CPT code 99204 and 99203?
The difference between CPT code 99203 and 99204 lies in the complexity and time. 99203 is used for visits of low complexity (30-44 minutes), while 99204 is used for moderate complexity (45-59 minutes).
What is the difference between 99214 and 99204?
For a 99204, all three major criteria (history, physical exam and medical decision making) must be met. A 99214 requires only two of the three major criteria. For a 99204, the review of systems must include at least 10 systems or body areas. A 99214 requires a review of only two.
What is CPT code 99204 and 99205?
Code 99204 requires a minimum of 45 minutes of face-to-face time with the patient and Code 99205 requires a minimum of 60 minutes face-to-face time with the patient. For both services, at least 50% of the face-to-face time must be spent providing counseling and/or coordination of care.
How to Code Evaluation and Management | Part 2 - MDM & Time Guidelines for 2024
What is CPT code 99204 charge?
CPT code 99204 is designated for new patient office or outpatient visits that require a moderate complexity in medical decision-making or 45-59 minutes of patient encounter time. Proper documentation and accurate code selection are crucial for maximizing reimbursement with CPT code 99204.
When to use 90792?
CPT Code 90792 description: Psychiatric Diagnosis Interview Examination (PDE) performed by a licensed mental health provider. According to CMS.gov, CPT Code 90792 requires: Elicitation of complete medical and psychiatric history (including past, family, social) Mental status examination.
What is an example of a 99204 visit?
If you are still not feeling confident in knowing what CPT code 99204 means, consider the following patient description example. A new adult patient visiting an office, or outpatient facility, for an acute illness or injury that requires medical management. The patient may even be eligible for surgical treatment.
Is 99214 a new patient code?
CPT® code 99214: Established patient office visit, 30-39 minutes | American Medical Association.
What is the CPT code for new patient annual exam?
The Annual Routine Physical Exam can be documented using codes 99385-99387 for new patients and codes 99395-99397 for established patients. When an Annual Wellness Visit and Annual Routine Physical Exam occur at the same date of service, no modifier is necessary.
What is the 3 year rule for new patients?
By CPT definition, a new patient is “one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.” By contrast, an established patient has received professional services from the physician or ...
What is the E&M code for a new patient?
To report an office or other outpatient visit for a new patient, you'll choose from E/M codes 99201-99205. As this article mentioned previously, office/outpatient visits include history, clinical examination, and medical decision-making (MDM) as the three key components for code selection.
Can you bill an office visit with a cast application?
A charge for procedure codes 29000-29590 is allowed only when the casting or strapping is a replacement procedure used during the period of follow-up care. The charge for an office visit is allowed only if significant identifiable further services are provided at the time of the cast application or strapping.
What is the code for an office visit?
Office or Other Outpatient Services CPT® Code range 99202- 99215. The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99202-99215 is a medical code set maintained by the American Medical Association.
What is the CPT code for new inpatient visit?
Initial hospital inpatient or observation care codes (99221-99223) are used to report the first hospital inpatient or observation encounter by the admitting physician.
What is the CPT code 99213 for a new patient?
CPT 99213 specifically describes a moderate-complexity office or outpatient visit. This code applies only to established patients—those who have previously been seen by the practitioner or another provider within the same group practice within the last three years.
How do you code a new patient visit?
CPT® code 99203: New patient office visit, 30-44 minutes | American Medical Association.
What is the CPT code for new patient office?
New Patient CPT® Code range 99202- 99205
The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99202-99205 is a medical code set maintained by the American Medical Association.
How do you know if its 99213 or 99214?
The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.
What is the CPT code 99204 for new patient office visit?
CPT Code 99204 Definition
99204 Description: Office or other outpatient visit for the evaluation and management of a new patient which requires a medically appropriate history and/or examination and moderate medical decision making.
When to use 99024?
99024 - Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure. Applies to surgeries with 90 and 10 day global periods.
What is the difference between 92004 and 99204?
With the proper chart documentation in place, the encounter can most often be coded as 99204 (E/M code) rather than 92004 (eye code). The national average differential between the two is $16.13, favoring the E/M code (Table 2). Over time, this difference can add up for any size practice.
What is the code 90837?
For CPT code 90837 (psychotherapy, 60 minutes with patient), a physician or other qualified health care professional can report a prolonged service code if the psychotherapy service, not performed with an E/M service, is 90 minutes or longer involving direct patient contact.
What is CPT code 99203?
CPT code 99203 is used for new patient office visits that require a medically appropriate history and/or examination and a low level of medical decision making. The typical time for a CPT code 99203 visit is 30-44 minutes. Proper documentation of the care components is essential to support billing for this code.
What is 96127?
CPT Code 96127 – Brief Behavioral Assessment. CPT Code 96127 may be used to report behavioral assessments in children and adolescents. CPT code description (AMA published) definition: Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument.