CPT Code 99205: Billing Guide & Reimbursement Rates [2022]

In our guide to CPT Code 99205, we’ll teach you about this straightforward complexity evaluation and management procedure code, 99205 guidelines for billing, and the CPT Code 92205 reimbursement rate for Medicare in 2022.

cpt code 99205

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CPT Code 99205 Definition

cpt code 99205 reimbursement rate

99205 Description:  Office or other outpatient visit for the evaluation and management of a new patient which requires a medically appropriate history and/or examination and high medical decision making.

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CPT Code 99205 Reimbursement Rate (Medicare, 2022): $244.99

In the past years, this E/m code has been paid $224.36 by Medicare in 2021.
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CPT Code 99205 Time Length: 60 – 74 Minutes

cpt code 99205 description

An average session length for an initial 99205 evaluation and management session is around 65 minutes.

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99205 Billing Guidelines:

Using CPT code 99205 requires a medical decision making level of high with a medically appropriate history or examination.

CPT CodeMedical Decision MakingTime LengthReimbursement Rate (2022)
99202Straightforward15 - 29 Minutes$80.91
99203Low30 - 44 Minutes$124.39
99204Moderate45 - 59 Minutes$185.26
99204High60 - 74 Minutes$244.99

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“In 2021, new patient codes 99202-99205 no longer require the three key components or reference typical face-to-face time. Instead, each service includes “a medically appropriate history and/or examination,” and code selection is based on the MDM [medical decision making] level or total time spent on that date.”

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This decision was made on 1/1/2021 to update the descriptor for Group 1 CPT and HCPCS codes 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215.

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Pick the code that is based on the length of service and complexity of medical decision making and appropriate level of care required.

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99205 Requirements:

  • Medical decision making:  high
  • Time length: 60 – 74 Minutes
  • Evaluation of clinical history and examinations

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