Reimbursement
$70.81
Threshold
15m
2026 Status
Active
What is CPT Code 99202?
CPT 99202 is defined as: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
This code is primarily used for E/M services. It falls under the category of Evaluation & Management and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.93
Physician Effort
PE (Non-Fac)
1.1
Practice Expense
Malpractice
0.09
Risk Factor
Total RVU
2.12
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (E/M service).
g2211 compatibility
Eligible for G2211 add-on if the provider serves as the focal point for all needed healthcare services.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
Straightforward MDM OR 15-29 minutes total time.
patient status
New patient (has not received professional services from the provider or group within 3 years).
frequency
Once per encounter.
Compliance Checklist
Audit Defense
time documentation
If billing by time, the exact number of minutes must be recorded, along with a summary of activities (reviewing records, patient exam, etc.).
2026 Update
Medicare 2026 continues to value E/M services based solely on MDM or total time, ignoring history/exam volume as scoring elements.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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