Neurology, coding reference.

99204 is the default code for most new-patient outpatient encounters in primary care and outpatient subspecialty practice. Use it for a new patient with at least one of: two or more chronic problems with progression or treatment changes; one undiagnosed new problem with uncertain prognosis; prescription drug management. Common patterns: new patient establishing primary care with multiple chronic comorbidities; new endocrinology consult for poorly controlled T2DM; new cardiology consult for chest pain and an abnormal stress test result. Prescription drug management satisfies moderate risk on its own, which makes 99204 the right code for the vast majority of new-patient continuity encounters. Time-based alternative is 45 to 59 minutes of total time on the date of the encounter.

Select this level when at least two of the three MDM elements meet high complexity, or when qualifying total time reaches 60 minutes. A diagnosis, medication, or high-risk decision alone does not establish the overall level. For Medicare prolonged services with this time-selected base code, the first G2212 unit requires 89 minutes. Payers recognizing CPT 99417 use different thresholds.

99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time.

Select this level when at least two of the three MDM elements meet high complexity, or when qualifying total time reaches 40 minutes. A diagnosis, medication, or high-risk decision alone does not establish the overall level. For Medicare prolonged services with this time-selected base code, the first G2212 unit requires 69 minutes. Payers recognizing CPT 99417 use different thresholds.

Consider the ongoing responsibility for the patient's care: either a continuing focal point for needed services or ongoing care of a serious or complex condition. It is not automatic for a diagnosis or specialty.

A detailed assessment and written care plan, not a brief cognitive screen. CMS describes a typical 60-minute visit with an independent historian; confirm the complete current requirements.

Extended routine EEG, 41-60 minute recording.

Routine outpatient awake + drowsy EEG.

NCS evaluation, 9-10 individual studies. 95912 for 11-12, 95913 for 13+.

NCS evaluation with 13+ individual studies (extensive workup, e.g. polyneuropathy).