99205
Office o/p new hi 60 min
New patient office or outpatient E/M visit, selected by high medical decision making or at least 60 minutes of qualifying total time on the encounter date.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
Billing guidance for 99205 is locked
- When to use it: the exact clinical situations that support billing 99205
- Documentation checklist: the 4 elements your note needs before submitting
- Common pitfalls: the 4 mistakes that get 99205 downcoded or denied
Payer notes
Medicare and CPT prolonged-service policies differ. Verify the payer, time-selected base service, threshold and applicable edits before reporting an add-on.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what 99205 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.