CPT 99202: Office Visit, New Patient, Straightforward
An office or other outpatient visit for the evaluation and management of a new patient with straightforward problems and minimal risk. Typical time: 10-19 minutes.
Why CPT 99202 Claims Get Denied
Claims billed under CPT 99202 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Patient not truly new (established in past 36 months)
Insufficient complexity for new patient level
Inadequate documentation of new patient elements
Incorrect billing as established patient
Billing Tips for CPT 99202
Verify patient status using 36-month lookback rule. Document new patient history elements separately from established patient record. Straightforward cases should be referenced to 99202 rather than inflating to higher levels.
Documentation Requirements
To support a clean claim for CPT 99202, your clinical documentation should include:
Detailed history of present illness
Complete past medical history
Complete family history
Complete social history
Focused physical examination
Simple medical decision making
Assessment and plan
Common Modifiers for CPT 99202
Reduce CPT 99202 Denials by 60%
RediClaim's pre-submission scrubber catches documentation gaps and coding errors before you submit, while the appeal generator handles denials that slip through.