One of the most common questions asked about 99202 is whether it is still a valid code.

That is a strange thing to ask about a code in daily use, and the reason people ask it is specific. 99202 is valid. The code immediately below it is the one that disappeared, and anyone who learned this system before 2021 is half-remembering a 99201 that no longer exists.

It went for a reason worth understanding, because the reason explains the shape of the whole range. Here is what 99202 is, what actually happened to 99201, why 99211 survived when 99201 did not, where the line sits against 99203, what the visit pays, and a documentation template with two worked examples.

Key Takeaway: CPT code 99202 is the office or other outpatient visit for a new patient with straightforward medical decision making, or 15 to 29 minutes of total time on the date of the encounter [1][2]. It is current, and it is now the bottom of the new patient range. 99201 was deleted in the 2021 evaluation and management revision, and the AMA's own instruction reads: 99201 has been deleted, to report, use 99202 [1]. The reason was redundancy rather than obsolescence. Under the old framework the two codes were separated by history and examination; once those stopped setting the level, both required straightforward decision making and nothing was left to tell them apart[1]. What the visit pays is not one number. Medicare computes the fee schedule amount as the relative value units (RVUs) for the service, multiplied by the geographic adjustment factor (GAF) for your fee schedule area, multiplied by the conversion factor (CF) [3], with a non-participating supplier paid 95 percent of the participating amount [3]. Sully.ai drafts the note with the detail that supports the level you actually delivered.

What CPT Code 99202 Is

99202 is the office or other outpatient visit for a new patient with straightforward medical decision making, or 15 to 29 minutes of total time on the date of the encounter [1][2].

It is the bottom of the new patient range. 99202 sits at straightforward, 99203 at low, 99204 at moderate, 99205 at high. There is nothing below it.

Straightforward Decision Making on a First Visit

Straightforward is reached by two of the three elements, the same two-of-three rule that governs every level.

Problems addressed reaches straightforward with one self-limited or minor problem.

Data reviewed reaches straightforward with minimal data or none.

Risk of management reaches straightforward with minimal risk of morbidity from additional diagnostic testing or treatment.

And here is the part that catches people out on a first visit. A new patient visit always involves taking a full history, because none of it is on file. History is not an element. Since the 2021 revision, history and examination are documented because they are clinically appropriate, not because they set the level [1][2].

So a thorough, careful, genuinely long first history for one minor problem is still a 99202. The history was necessary. It just does not count toward the code.

The Two Routes to 99202

You need one route, not both. Either 15 to 29 minutes of total time on the date of the encounter, or straightforward medical decision making [1][2].

The full framework, including how two of three works across all four levels, is in the 99214 article.

Why 99201 Is Gone, and Why 99202 Is Not

What the AMA Actually Said

The instruction is short and unambiguous. In the AMA's 2021 evaluation and management materials, the entry for the old code reads: "99201 has been deleted. To report, use 99202" [1].

The same document lists it among the major revisions for that year: "Deletion of code 99201 and revision of codes 99202-99215" [1]. The accompanying note adds that guidelines and parenthetical notes throughout the code set were updated to reflect it [1].

A second, independent source agrees. The current CMS evaluation and management booklet contains no occurrence of 99201 anywhere, and writes the new patient office visit range as beginning at 99202 [2].

So: 99202 is valid and current. 99201 is not. If you are reaching for a code below 99202, you are reaching for one that was removed six years ago.

The Reason It Went

This is the part nobody explains, and it is more interesting than a deletion notice.

Before 2021, office visit levels were set by three key components: history, examination, and medical decision making. 99201 and 99202 were separated largely by how much history and examination each required.

The 2021 revision removed history and examination as level-setting elements and replaced them with medical decision making or total time [1][2].

The AMA's own summary states the consequence directly: codes 99201 and 99202 both required straightforward medical decision making [1].

Read those two facts together. Once the elements that distinguished the two codes stopped counting, there was nothing left to distinguish them. Two codes described the same thing.

99201 was not deleted because the service stopped happening. It was deleted because the thing separating it from 99202 stopped existing. The work it described did not go anywhere. It is billed as 99202 now, which is exactly what the instruction says to do.

The document's own time table makes the handover concrete. Under the 2020 rules 99201 carried a typical time of 10 minutes; in the 2021 column that row reads code deleted. 99202 moved from a typical 20 minutes to a total time range of 15 to 29 minutes [1].

Why 99211 Survived and 99201 Did Not

Here is a question most people never think to ask: why does the new patient range have four codes and the established patient range five?

It looks like an inconsistency. It is not.

99211 was not deleted, and the reason is that it is not a lower decision making level of the same service. It is the established patient office or outpatient visit that may not require the presence of the physician or other qualified health care professional[2]. In most practices it is the nurse visit code.

That makes it a different kind of encounter rather than a smaller version of 99212. The 2021 revision collapsed 99201 into 99202 because the two described the same work at the same decision making level. It had no reason to do anything of the kind to 99211, because 99211 was never the same kind of thing.

The asymmetry between the two ranges is the direct result of that. One code was redundant. The other was not comparable.

99202 or 99203

Source [1][2]. The detail on 99203 is in its own article.

The crossing here is the same one the 99212 article works through in depth for the established side, and the reasoning transfers directly.

On problems. One self-limited or minor problem is straightforward. One stable chronic illness, or two or more self-limited problems, is low. That one word carries most of the difference.

On data. None or minimal is straightforward. The element moves the moment a test is ordered, an outside record is actually read, or a result is compared rather than noted.

On risk. Minimal is straightforward. A management decision with any real consequence has already left straightforward behind, including one you weighed and declined.

On time. 29 minutes is a 99202. 30 minutes is a 99203 [1].

99202 or 99212

Same decision making level, different patient, different clock.

99202 is a new patient at 15 to 29 minutes. 99212 is an established patient at 10 to 19 [1][2]. Both sit at straightforward, so on the decision making route they ask for the same thing.

The new patient codes run on a longer clock than the established codes at every matching level, which is covered in the 99204 article.

What 99202 Actually Pays

There is no single national figure.

Under 42 CFR 414.20, the fee schedule amount for a participating supplier is computed as the RVUs for the service, multiplied by the GAF for the fee schedule area, multiplied by the CF [3]. Two of those three move: the geographic adjustment factor differs in every fee schedule area, and the conversion factor is set annually and revised most years.

RVUs are established separately for physician work, practice expense and malpractice insurance [4], and the practice expense component is lower in a facility than in an office. A non-participating supplier is paid 95 percent of the participating amount [3].

Get your own figure from the CMS Physician Fee Schedule Look-Up Tool [5]: the year, the code, your Medicare Administrative Contractor (MAC) locality, and facility or non-facility. Commercial payers set their own rates separately. The work RVU, which answers a different question, is covered in the 99204 article.

One warning, because this is a live trap. Older guidance about the 2021 changes circulates with payment figures attached, some of it from 2018 and 2019. Those numbers are now years out of date and were in some cases only proposals. Treat any dollar figure you find attached to this code as expired until you have checked it in the lookup tool yourself.

Why a 99202 Comes Back

The patient was not new. No professional service from a same-specialty clinician in your group within three years is the test, and the three year rule is covered in full in the 99204 article. The payer checks this against its own claims history rather than against your note.

The note reaches low, not straightforward. On a first visit the commonest version of this is a full history mistaken for complexity. History has not set the level since 2021 [1]. A long history does not make a small problem a bigger one.

Time was recorded without being qualified. A figure that does not say it is total time on the date of the encounter, counting only the reporting clinician, does not support the time route.

The diagnosis does not support medical necessity. The visit can be documented perfectly and still be denied if the submitted diagnosis does not justify it.

The 99202 Documentation Template

One block, complete as written. Paste it straight into a chart, or start from the progress note template and add the new patient lines.

OFFICE VISIT, NEW PATIENT, STRAIGHTFORWARD

• Patient, date of service: (and the rendering clinician)

• New patient confirmation: (no professional service from a same-specialty clinician in this group within three years, with the date checked)

• Referral source: (who sent them, or self referred)

• Chief complaint: "(in the patient's words)"

• History: (the full history, taken because it is clinically appropriate; note that it does not set the level)

• Examination: (findings relevant to the problem addressed, with values)

• Problem addressed today, and its status: (name it, and write self-limited or chronic; this word is what separates 99202 from 99203)

• Data reviewed: (or write "none", because an explicit none is evidence and a blank line is not)

• Risk of management selected: (what you decided, and why the risk of that decision is minimal)

• Route used: (time, or medical decision making; state which)

• If time: (total time on the date of the encounter, stated in those words, counting only this clinician)

• Assessment and plan: (the decision, and what happens next)

• Signature, credentials, date: (the clinician who performed the service)

Two lines do the work here. "Problem addressed today, and its status" forces the word that decides the level. And the parenthetical on the history line exists because the single most common error on this code is a clinician looking at a page of careful history and concluding the visit must have been more than a 99202.

Where Sully.ai Fits in a Short First Visit

A first visit is the longest history a clinician ever takes. On a 99202, none of it sets the level.

What does set the level is three short lines that a long history tends to bury: the problem and its status, the data reviewed or an explicit none, and the risk of what was decided. Those are the lines most likely to be compressed into something like "seen, reassured, no treatment" when the note is written three patients later.

Sully.ai's AI scribe drafts the note from the visit, so the problem is named with its status, the data is recorded or explicitly absent, and the decision is stated. It runs on a single integration across Epic, Cerner, Meditech and Athenahealth.

Two boundaries, and both are refusals.

Nothing should choose the code. Code selection is your attestation, it is what a reviewer examines, and it carries liability belonging to the person who saw the patient.

No documentation tool adds to your clock. Only the reporting clinician's own time counts toward the time route [2]. A scribe of any kind does not move a visit from 29 minutes to 30.

Sully operates across 5,000+ providers, has delivered 50M+ hours of work, and prices each role 80 to 90 percent below the human equivalent [6].

Two Worked Examples

A First Visit That Is Clearly 99202

New patient, self referred, walk-in appointment. 23 minutes total time on the date of the encounter.

New patient confirmation :No professional service from any family medicine clinician in this group. Chart search returns no prior encounters.

Referral source: Self referred.

Chief complaint: "I've had this itchy patch on my arm for about a week."

History:26 year old woman, previously well. Itchy, scaly patch on the right forearm for 8 days, appearing a day after a weekend gardening. No spread, no blistering, no fever, no joint pain. No history of eczema, psoriasis or asthma. No new soaps, detergents or cosmetics. Not pregnant, no regular medications, no known allergies. Full past medical, surgical, family and social history taken and recorded, since none was on file.

Examination: Temperature 98.1 F. Blood pressure 112/70. Well demarcated erythematous scaly patch, approximately 4cm by 3cm, on the extensor surface of the right forearm. No vesicles, no excoriation, no secondary infection. No other skin involvement on examination of the exposed areas. No lymphadenopathy.

Problem addressed today, and its status: Contact dermatitis of the right forearm, self-limited, acute and uncomplicated.

Data reviewed: None. No investigation indicated.

Risk of management selected: Advice and an over-the-counter emollient. No prescription issued, nothing ordered. Minimal risk.

Route used: Medical decision making.

If time: Total time on the date of the encounter, counting only this clinician: 23 minutes, comprising the encounter, taking and recording the full history, and documentation.

Assessment and plan: Contact dermatitis, likely plant contact during gardening. Emollient and avoidance advised, gloves recommended for future garden work. No topical steroid required at this stage. Return if it spreads, blisters, or has not settled in two weeks. No routine follow-up arranged.

Why this is a 99202. One self-limited problem puts problems at straightforward. No data was reviewed, and that is a clinical decision rather than an omission, so data is straightforward. Nothing was prescribed and nothing was ordered, so risk is minimal. Three elements at straightforward where two were needed.

And notice what did not matter. A full past medical, surgical, family and social history was taken, because this patient has no record here and it had to be. It took real time and it was clinically correct. It contributed nothing to the level [1]. The visit also sits in the 15 to 29 minute band, so both routes support the code.

A First Visit That Is Actually a 99203

New patient, same clinic, same week. 26 minutes total time, which is still inside the 99202 band.

New patient confirmation: No professional service from any family medicine clinician in this group within three years.

Referral source: Self referred, registering after changing insurance.

Chief complaint:"I need someone to take over my blood pressure tablets."

History: 58 year old man, essential hypertension diagnosed 2019, on amlodipine 5mg daily for the past three years. No headaches, no chest pain, no breathlessness, no ankle swelling. Takes the medication consistently. No other conditions, no other medications. Full history taken and recorded.

Examination: Blood pressure 134/84, repeated 132/82. Heart rate 70 regular. Body mass index 27. Chest clear. No peripheral edema. Fundoscopy normal.

Problem addressed today, and its status: Essential hypertension, chronic, stable and close to target.

Data reviewed: Blood pressure log from the previous practice, obtained and read, showing home readings averaging 131/80 over the past three months. Most recent basic metabolic panel from that practice reviewed, within normal limits.

Risk of management selected: Dose increase considered given readings slightly above target, and decided against on the basis of consistent home readings and no end-organ signs. Continuing amlodipine 5mg daily unchanged, with a review interval set. Low risk.

Route used:Medical decision making.

If time:Total time on the date of the encounter, counting only this clinician: 26 minutes, comprising the encounter, requesting and reading the transferred records, and documentation.

Assessment and plan:Essential hypertension, stable on current therapy and acceptably controlled. Continue amlodipine 5mg daily. Home readings to continue. Repeat basic metabolic panel and lipids in 3 months. Review in 3 months, sooner if home readings rise consistently above 140/90.

Why this is a 99203, and where the genuine fork is.

Three things moved, and none of them made the visit longer.

The problem is chronic, not self-limited. One stable chronic illness reaches low under problems addressed. That is the word the template line exists to capture.

Data was reviewed. Outside records were obtained and actually read, and a home reading log was interpreted as a trend. That moves data off minimal.

A decision was weighed. The dose increase was considered and rejected for a stated reason, and a monitoring interval was set as a result.

Two of three at low is the bar, and this visit clears it.

And the time route genuinely points the other way. 26 minutes sits inside the 99202 band of 15 to 29 [1]. A note relying on time alone would support 99202. This one relies on decision making, which supports 99203, and the note says which route it used. That is exactly why the route line is in the template.

The second visit was not longer than the first. It was different, and the difference is three short lines in the note rather than anything a stopwatch would have caught.

FAQ

What is CPT code 99202?

The office or other outpatient visit for a new patient with straightforward medical decision making, or 15 to 29 minutes of total time on the date of the encounter [1][2].

Is 99202 still a valid CPT code?

Yes. 99202 is current and is the lowest code in the new patient office visit range. The code people are usually thinking of is 99201, which was deleted in the 2021 evaluation and management revision. The AMA's instruction is that 99201 has been deleted and that to report it you use 99202 [1]. The current CMS evaluation and management booklet contains no 99201 and lists the range as beginning at 99202 [2].

Why was 99201 deleted?

Because it stopped being distinguishable from 99202. The two codes were separated by history and examination under the old framework, and the 2021 revision removed those as level-setting elements. The AMA's summary notes that both codes required straightforward medical decision making [1], so once history and examination stopped counting, nothing separated them. The work 99201 described is now reported as 99202.

What is the difference between 99203 and 99202?

The level of medical decision making, or the time. 99202 is straightforward, or 15 to 29 minutes. 99203 is low, or 30 to 44 [1][2]. In practice the difference usually turns on one word: a self-limited problem is straightforward, a stable chronic illness is low.

What is the difference between CPT code 99202 and 99204?

Two levels. 99202 is straightforward decision making, or 15 to 29 minutes. 99204 is moderate, or 45 to 59 [1][2]. 99203 sits between them at low, or 30 to 44 minutes. All three require a new patient.

How much does 99202 pay?

There is no single national figure. Medicare computes the fee schedule amount as the RVUs for the service multiplied by the geographic adjustment factor for your area and the conversion factor [3], so it varies by locality and by year. A non-participating supplier is paid 95 percent of the participating amount [3]. Get the current figure for your locality from the CMS Physician Fee Schedule Look-Up Tool [5]. Be careful with dollar figures attached to older articles about the 2021 changes, since some of those date from 2018 and 2019.

Sources

[1] American Medical Association — Evaluation and Management (E/M) Office Visits, 2021. https://www.ama-assn.org/media/61016/download

[2] Centers for Medicare & Medicaid Services — Evaluation and Management Services, MLN006764, May 2026. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf

[3] U.S. Government Publishing Office — 42 CFR 414.20, Formula for computing fee schedule amounts. https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol3/xml/CFR-2023-title42-vol3-sec414-20.xml

[4] U.S. Government Publishing Office — 42 CFR 414.22, Relative value units (RVUs). https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol3/xml/CFR-2023-title42-vol3-sec414-22.xml

[5] Centers for Medicare & Medicaid Services — Physician Fee Schedule Look-Up Tool. https://www.cms.gov/medicare/physician-fee-schedule/search

[6] Sully.ai — AI Medical Scribe. https://www.sully.ai/medical-scribe