The rules for new office patients are changing starting on January 1, 2021. The information below will NO LONGER apply to these encounters.

Click HERE to see our 2021 E/M Coding Update Course.

Level 5 New Patient Office Visit (99205)

The 99205 represents the highest level of care for new patients seen in the office.  This is the third most popular code used to bill for these encounters among internist who selected the 99205 level of care for 15.34% of new office patients in 2018.  The 2020 Medicare allowable reimbursement for this level of care is $211.12 and it is worth 3.17 work RVUs. Usually the problems are of moderate to high severity.

The documentation for this encounter requires THREE out of THREE of the following :

1)  Comprehensive History
2)  Comprehensive Exam
3)  High Complexity Medical Decision-Making

Or 60 minutes spent face-to-face with the patient if coding based on time.The appropriate documentation must be included.

Clinical Example

This topic is covered in more detail in of one of our web-based E/M coding courses.
New Office Patients
		Related Topics
		Level 1 New Office Visits Level 2 New Office Visits Level 3 New Office Visits Level 4 New Office Visits
Now that the consult codes have been eliminated for Medicare patients, the new office patient visit has become the most common outpatient initial encounter. Learn exactly what needs to be documented for each level of care for these visits. All levels of care are discussed.
		For mutliple users, consider an E/M Compliance Web Portal.