What Is the 99205 CPT Code?
The 99205 CPT code is used to bill for a new patient office visit at the highest level of complexity. It falls under the Evaluation and Management (E/M) category and is specifically for outpatient or office settings.
The 99205 CPT code description from the American Medical Association (AMA) covers visits that require either a high level of medical decision-making or a significant amount of physician time on the date of the encounter.
A “new patient” here means someone who has not been seen by that physician or any physician in the same group practice and specialty within the past three years.
99205 CPT Code Description and Time Requirements
One of the most asked questions is about the 99205 CPT code time threshold. Since the 2021 E/M guideline updates, time can be used on its own to justify a code level — you no longer need to meet all three components of history, exam, and medical decision-making.
For 99205, the total time on the date of the encounter must be 60 to 74 minutes.
This total time includes more than just face-to-face interaction.
