CPT® 99205: new patient office visit, high MDM
CPT® 99205 reports an office or other outpatient visit for a new patient. Since 2021 it is selected by one of two paths: high medical decision making, or at least 60 minutes of the practitioner’s total time on the date of the encounter.
Selecting 99205 by medical decision making
MDM has three elements: the number and complexity of problems addressed, the amount and/or complexity of data to be reviewed and analyzed, and the risk of complications and/or morbidity or mortality of patient management. To report 99205, two of the three must meet or exceed the high level. The AMA's Table 2 defines that level as follows; the data element has its own category rules, listed in the source.
| Element | High level |
|---|---|
| Problems addressed |
|
| Data reviewed and analyzed | Extensive (must meet 2 of 3 categories) |
| Risk of patient management | High risk of morbidity from additional diagnostic testing or treatment
|
Selecting 99205 by time
When the level is selected by time, 99205 requires at least 60 minutes of the physician's or qualified health care professional's total time on the date of the encounter, face-to-face and non-face-to-face. The 2021 code set listed it as 60–74 minutes; the current CPT® code set is the authority for the exact descriptor. Activities that count, and the ones that do not, are listed in the total time section of the guide.
When a time-based visit runs past 99205, CPT® code 99417 is reported for each additional 15 minutes; 99205 with one unit covers 75–89 minutes. Medicare uses HCPCS code G2212 instead, counted beyond the maximum time of 99205, so one unit covers 89–103 minutes under CMS guidance.
What the note has to show
Because two of the three elements must be met, a note that supports 99205 by MDM has to make at least two of them visible at the high level: the problems addressed and their status, the data reviewed or ordered, or the management decisions that carry the risk. A note that supports 99205 by time has to record the total time on the date of the encounter. The MedChartScan E/M audit reads the note for these elements and shows the passages it used, so the level can be checked against the text before the claim goes out.
Nearby codes
- Same level for an established patient: 99215
- One level down: 99204
- All office and outpatient codes: the code table in the guide
Questions
How many minutes is 99205?
When the level is selected by time, 99205 requires at least 60 minutes of the practitioner’s total time on the date of the encounter; the 2021 code set listed it as 60–74 minutes. The level can also be reached by high medical decision making regardless of time.
What level of medical decision making is 99205?
High. Two of the three MDM elements (problems addressed, data reviewed and analyzed, and risk of patient management) must meet or exceed the high level.
Is 99205 for new or established patients?
New patients. The established-patient code at the same level is 99215.
When is prolonged service time added to 99205?
Only when the visit is selected by time and the total time exceeds 99205. CPT® 99417 is reported for each additional 15 minutes (99205 with one unit covers 75–89 minutes). Medicare uses HCPCS G2212 instead, counted beyond the maximum time of 99205 (one unit covers 89–103 minutes under CMS guidance).
Sources
- CPT® Evaluation and Management (E/M) Office or Other Outpatient and Prolonged Services code and guideline changes, effective January 1, 2021 (opens in a new tab) — American Medical Association (with March 9, 2021 technical corrections)
- Evaluation and Management Services (MLN006764), May 2026 revision (opens in a new tab) — Centers for Medicare & Medicaid Services
Last reviewed September 29, 2026 · CPT® is a registered trademark of the American Medical Association · Full guide: How E/M coding works