99202
Office o/p new sf 15 min
Office or other outpatient visit, new patient, straightforward medical decision making OR 15 to 29 minutes of total time on the date of the encounter. The CMS 2026 wRVU for 99202 is 0.93. The lowest-paying new-patient E/M code; reserved for truly straightforward presentations.
When to use it
99202 is the new-patient code for a single stable, minor problem with simple management. Common patterns: a new patient with a single uncomplicated acute illness (uncomplicated URI, minor dermatologic complaint, simple mechanical low back pain), a new healthy patient establishing care with no chronic conditions, or a new patient with a single very stable condition not requiring medication management.
Full guidance
The three-year rule for new-patient status is firm: a patient is new only if neither you nor a same-specialty colleague in your practice has seen them face to face within the past 36 months. Most new-patient encounters in primary care actually meet 99203 or 99204 criteria; 99202 is uncommon in practice.
Documentation checklist
- ✓MDM straightforward: one self-limited or minor problem, minimal or no data review, and minimal risk.
- ✓Time alternative: 15 to 29 minutes of total physician or QHP time on the date of the encounter.
- ✓Three-year rule confirmed for new-patient status.
- ✓Time-based encounters: document the time and qualifying activities (chart review, history, exam, ordering, counseling, documentation, care coordination on date of encounter).
- ✓Pick one method per encounter. Mixing time and MDM is an audit liability.
Common pitfalls
- !Up-coding to 99203 or 99204 without supporting MDM. Most new-patient encounters have at least limited data review or low-complexity MDM, which moves them to 99203.
- !Billing as new when a same-specialty colleague saw the patient in the past 3 years. CMS audits this via claims-history matching.
- !Down-coding to 99202 for an encounter that actually met 99203 criteria. Under-coding is also a problem and costs straight wRVU.
- !Time-based 99202 with vague time documentation. Audit-proof language requires both the total time and the qualifying activities.
- !Forgetting G2211 add-on when you are the new continuity provider. G2211 attaches to 99202 when the longitudinal-care relationship is being established.
Payer notes
Medicare and commercial payers cover 99202 routinely. The three-year rule is audited via claims history. Sub-specialty within the same group is treated as the same specialty under the rule for some payers but not others; verify your contract. For telehealth, Medicare allows POS 10 (home) or POS 02 (other) with modifier 95.