The Definitive Resource for Understanding New Patient CPT Codes

In Medical Billing, CPT (Current Procedural Terminology) codes are necessary as they represent the medical service provided by the healthcare provider. 

Even though it is complex, healthcare professionals should stay updated with the current procedural terminology codes for accurate billing. This blog post shares everything you need to know for understanding New Patient CPT Codes.

Definition of New Patient CPT Codes

New Patient CPT Codes are specific billing codes used for New patients who have not received any healthcare service for the past three years. The Healthcare service represents professional services from the physician or another physician of the same specialty in the same group practice.

These New Patient CPT codes are crucial for accurate medical billing and getting proper reimbursements. It typically has more high reimbursement rates than established patients. 

They account for the additional time and resources required to gather a complete medical history, perform a thorough examination, and establish a treatment plan for a new patient.

Here are the key highlights of the New Patient CPT Codes:

• For patients not seen within 3 years
• More comprehensive than established patient visits
• Higher reimbursement rates
• Essential for accurate billing
• Misuse can lead to audits

Related: Orthopedic Billing: The Best Practices to Get Faster Reimbursements (Coding Cheat Sheet)

The New Patient CPT Codes Range: 99201 – 99205

The New Patient’s current procedural terminology code ranges from 99201 – 99205. These are the 5 New Patient CPT Codes used for new patient office visits. 

These CPT Codes are categorized by:

• Time spent with the patient
• Detail of history taking
• Extent of the physical examination
• The complexity of medical decision-making

1. CPT Code 99201

The CPT code 99201 is used for billing a new patient office visit with the lowest level of complexity. This means the visit involves a focused problem, straightforward medical decision-making, and minimal severity.

• Level 1 New Patient
• A brief description of the main reason for the new patient visit.
• While there wasn’t a strict time limit, it typically involved very brief visits averaging around 10 minutes.
• Involved minimal risk and treatment options with minimal data to consider.
• Limited to one body system with 1-5 elements examined.

2. CPT Code 99202

A new patient’s evaluation and management in an office or other outpatient setting necessitates a medically necessary history, examination, and simple prescription decision-making.

• Level 2 New Patient
• Medicare, 2024 has paid the E/M code $71.06.
• An average session for the 99202 evaluation is around 20 minutes (15-29 Minutes).
• Straight-forward level of medical decision-making with a medically appropriate history or examination.

3. CPT Code 99203

A medically adequate history, examination, and/or low degree of medical decision-making are required during an office or other outpatient visit for the evaluation and care of a new patient. 

• Level 3 New Patient
• The E/M code has been paid $109.69 by Medicare, in 2024.
• An average session for the 99203 evaluation is around 35 minutes (30 – 44 Minutes).
• Low level of medical decision-making with a medically appropriate history or examination.

4. CPT Code 99204

A new patient’s evaluation and care may involve an office visit or another type of outpatient visit that calls for a medically necessary history, examination, and/or moderate level of medical decision-making.

• Level 4 New Patient
• The E/M Code has been paid $164.38 by Medicare, in 2024.
• An average session for the 99204 evaluation is around 50 Minutes (45 – 59 Minutes).
• Moderate level of medical decision-making with a medically appropriate history or examination.

5. CPT Code 99205

A new patient’s evaluation in an office or other outpatient setting necessitates a medically necessary history, examination, and high-level medical decision-making.

• Level 5 New Patient
• The E/M Code has been paid $216.77 by Medicare, in 2024.
• An average session for the 99205 evaluation is around 65 Minutes (60 – 74 Minutes).
• High level of medical decision-making with a medically appropriate history or examination.

Related: How to Easily Tackle Denials in Wound Care Billing to Improve Cash Flow

New Patient vs Established Patient: The Key Differences

There are a few key differences between New Patients and Established Patients. Here they are:

New Patient	Established Patient
New patients didn’t receive any medical services in the past 3 years.	The Established patient has received medical services in the past 3 years.
A New patient has to provide a detailed medical history during the first visit.	The established patient just has to update their medical history if there have been any changes.
New patient appointments are typically longer to allow for a comprehensive medical history review and examination.	Established patient appointments may be shorter depending on the reason for the visit.

Revenue Cycle Management Solution from CapMinds

Effective revenue cycle management is essential to improve healthcare practices’ financial health. To avoid the drawbacks, minimize claim denials, and improve your revenue cycle management, an expert must be put into use in your practice.

At CapMinds, we are bringing a comprehensive solution to make your billing and coding experience better. Our medical billing team expedites your entire billing process. Utilizing our Revenue Cycle Management Solution, your healthcare practice benefits from:

• 24/7 Support: Always available for your queries.
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• Compliance and Security: Adhere to industry standards always.

We optimize your charges, submit your claims, on-time collection, reduce accounts receivables, identify underpayments, and increase your practice’s net collections, thereby better clinical and service expansion.

We also have a dedicated client manager who will be exclusively assigned to you. And the team will be available around the clock to assist with your queries. 

“Reach out to CapMinds to make your medical billing process easier and more effective”