These codes are used to report E/M services for new office patients. There used to be five levels of care for these encounters, but now there are only four. There is significant variability in payment, depending upon the code billed, so it is important to select the level of care which matches the clinical circumstances of the patient in order to optimize reimbursement.
For these encounters, the level of care may be selected based on the MDM required for the visit OR based on time spent.
The rules for performing and documenting new office visits are covered extensively in the NEW OFFICE PATIENTS course, which includes examples for all four levels of care as well as detailed explanations of the MDM and time required for each visit.
The 99201 level of care has been deleted.
The 99202 level of care for new office patients (otherwise known as a level 2 new office visit) is the lowest level of care for new office visits. This level of care requires only straightforward medical decision-making or a total of fifteen minutes of time spent.
The 99202 level of care is used for about 4% of new office visits among internists and pays about $75.
The 99203 level of care for new office patients (otherwise known as a level 3 new office visit) requires low complexity medical decision-making or a total of thirty minutes of time spent.
The 99203 level of care is used for about 23.8% of new office visits among internists and pays about $118.
The 99204 level of care for new office patients (otherwise known as a level 4 new office visit) requires moderate complexity medical decision-making or a total of forty-five minutes of time spent.
The 99204 level of care is used for about 55.6% of new office visits among internists and pays about $177.
The 99205 level of care for new office patients (otherwise known as a level five new office visit) is the highest level of care for new office visits. This level of care requires high complexity medical decision-making or a total of sixty minutes of time spent.
The99205 level of care is used for about 16.5% of new office visits among internists and pays about $237.
The rules for performing and documenting new office visits are covered extensively in the NEW OFFICE PATIENTS course, which includes examples for all four levels of care as well as detailed explanations of the MDM and time required for each visit.