99205
E/M NewCMS status: AOffice or other outpatient visit, new patient, high-level MDM or 60-74 minutes total time.
Work RVU
3.50
Practice RVU
3.23
Malpractice RVU
0.36
Total RVU
7.09
2026 Medicare payment
$236.81
National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility
Model this code
Drop 99205 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
New patient with severe, decompensated, or high-acuity disease. Complex consult-style new patient encounters.
Documentation checklist
- ✓MDM: high complexity OR 60-74 minutes total time.
- ✓Document the high-risk element (admission consideration, intensive monitoring, drug toxicity).
Common pitfalls
- !Inflating new patient complexity without supporting MDM elements.
- !Skipping G2211 — high-complexity new patients in continuity care are still eligible.
Common modifiers
2595
Common ICD-10 pairings
C50.911I50.22E11.65
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.