Office or outpatient visit for a new patient that needs only straightforward medical decision making, or at least 15 minutes of total physician time that day.

3 sources ↓

Medicare: $75.15
Work RVU: 0.93
Global, days
Region: General

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 3 cited references ↓

Chief complaint and pertinent history
Exam relevant to the complaint
Assessment and plan showing straightforward MDM, or total time on the date of service
Confirmation the patient is new to the physician and same-specialty group in three years
Any data reviewed or ordered

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 57 Decision for surgery 95 Modifier

What this code covers

Source · Editorial summary grounded in 3 cited references ↓

99202 is the lowest new patient office visit. It fits a simple, self-limited problem: a minor finger sprain, a quick look at a healed abrasion, a patient sent in for a single question with no workup needed. Code by MDM or by total time on the date of service, whichever supports the higher level.

New patient means no professional services from the same physician, or another physician of the same specialty and subspecialty in the group, within three years. In ortho groups this trips people up when a patient saw a partner in the same subspecialty two years ago. That patient is established.

Most new ortho visits land at 99203 or 99204. An acute injury plus even an over-the-counter medication recommendation already meets low MDM. If closed fracture care is billed the same day, remember those codes carry a 90-day global, so the visit where the decision to treat is made takes modifier 57, not 25.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (0.93) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.25) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	0.93
Practice expense RVU	1.25
Malpractice RVU	0.07
Total RVU	2.25
Medicare national rate	$75.15
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$75.15

Common denial reasons

The recurring reasons claims for CPT 99202 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Patient was seen by a same-specialty partner within three years, so a new patient code is invalid
Billed with a minor procedure without modifier 25
Time documented as a range or template, not actual minutes
Diagnosis does not support medical necessity

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 3 cited references ↓

01What is the time requirement for CPT 99202?

99202 requires at least 15 minutes of total physician or qualified provider time on the date of service when coding by time.

02When does a patient count as new for 99202?

When they have not received professional services from the same physician or a same-specialty, same-subspecialty colleague in the group in the past three years.

03Can I bill 99202 with an injection?

Yes, with modifier 25, if the evaluation goes beyond the decision to inject. A visit only to perform a planned injection does not support a separate E/M.

04Is 99202 used much in orthopedics?

Not often. Most new ortho complaints are at least an acute uncomplicated injury, and once a treatment decision is made the MDM usually reaches 99203 or higher.