Reimbursement
$223.78
Threshold
60m
2026 Status
Active
What is CPT Code 99205?
CPT 99205 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 high level of medical decision making. When using time for code selection, 60-74 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
3.5
Physician Effort
PE (Non-Fac)
2.89
Practice Expense
Malpractice
0.31
Risk Factor
Total RVU
6.7
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).
valuation premium
99205 provides the highest E/M outpatient reimbursement ($220.45) for cognitive cognitive work.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
High MDM OR 60-74 minutes total time.
patient status
New patient.
frequency
Once per encounter.
Compliance Checklist
Audit Defense
mdm high
Requires documented evidence of extensive data review and high risk of morbidity/mortality from the illness or the treatment.
2026 Update
Prolonged services (G2212) can be added ONLY if time exceeds 74 minutes in the outpatient setting.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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