How does CPT 99202 compare to other E/M codes?

CPT 99202 is part of the Evaluation and Management services for Office or Other Outpatient Services. It represents a moderate-complexity encounter, involving more provider time and moderate medical decision-making compared to lower-level codes. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements than simpler assessments.

How can I access detailed fee schedules?

You can access detailed provider-level rates and fee schedules by signing up for a trial account with PayerPrice or scheduling a demo. This allows you to view complete data and compare your rates against market averages.

CPT 99202 Fee Schedule

Q: What factors affect fee schedules?

Fee schedules are affected by Medicare & Medicaid Rates (government-set reimbursement amounts), Private Insurance Rates (negotiated rates between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

Q: What is CPT 99202 used for?

CPT 99202 is used by healthcare providers to document and receive reimbursement for Office or Other Outpatient Visits for a new patient. It addresses moderate-level medical decision-making, often including multiple diagnoses or prescription management. It requires a medically appropriate history and/or examination and straightforward medical decision making, or 15 minutes of total time on the date of the encounter.

Last Verified: February 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)

Key Fact	Detail
Service Type	• Evaluation and Management • Office or Other Outpatient Services
Common Place of Service	• 11 - Office • 20 - Urgent Care Facility
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • GT - Via interactive audio and video telecommunication systems
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99202

National average reimbursement for CPT 99202 by major payers:

$83.09

$82.41

$80.62

$109.17

Preview provider-level rates for...

For billing codeCPT 99202

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99202
United	99202	$109.44	1669867552 - GREGORY COFFMAN	590704934 - WATSON CLINIC LLP	FL	Cardiovascular Disease Physician (207RC0000X)
United	99202	$84.51	1225624729 - SHAVAUN JOHNSON	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	MO	Psychiatric/Mental Health Nurse Practitioner (363LP0808X)
United	99202	$84.51	1942668785 - SARAH LANGHAM	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	MD	Psychiatric/Mental Health Registered Nurse (163WP0808X)
United	99202	$84.51	1639652829 - CASSANDRA GILLIAM	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	GA	Psychiatric/Mental Health Nurse Practitioner (363LP0808X)
United	99202	$84.51	1215637863 - VICTOR NWAGWU	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	VA	Psychiatric/Mental Health Nurse Practitioner (363LP0808X)
United	99202	$145.44	1225565864 - ANA MARTINEZ-TAPIA	208853938 - (NY) MEETING HOUSE LANE MEDICAL PRACTICE PC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$61.47	1316760697 - SANILA SIDDIQUI	841905435 - (FL) GOODLESS DERMATOLOGY LLC	FL	Physician Assistant (363A00000X)
United	99202	$84.51	1467882522 - STACY DILIBERTO	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	LA	Clinical Social Worker (1041C0700X)
United	99202	$70.04	1043221450 - MICHAEL BERNSTEIN	900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$65.02	1083651376 - SHIRLEY SOUTHARD	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	NC	Professional Counselor (101YP2500X)
United	99202	$41.11	1225017007 - FRANK RAMHARRACK	593492235 - (FL) FRANK M RAMHARRACK MD PA	FL	Endocrinology, Diabetes & Metabolism Physician (207RE0101X)
United	99202	$69.94	1831552165 - KEVIN YEROUSHALMI	113465690	NY	Gastroenterology Physician (207RG0100X)
United	99202	$84.51	1598275950 - CHRISTINA BAFFUTO	862493019 - MENTAL HEALTH SPECIALTY GROUP PA	NY	Mental Health Counselor (101YM0800X)
United	99202	$74.30	1992051635 - MAGDA DAOUD	263381883 - AMBOY MEDICAL PRACTICE PC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$64.12	1124094024 - CRISTINA LOPEZ-PENALVER	205155995	FL	Surgery Physician (208600000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 99202 vs. Other Office or Other Outpatient Services Codes

The CPT 99202 code is part of the Evaluation and Management services used for Office or Other Outpatient Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99202 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99184-CPT	Moderate	Initiation Of Selective Head Or Total Body Hypothermia In The Critically Ill Neonate Includes Appropriate Patient Selection By Review Of Clinical Imaging And Laboratory Data Confirmation Of Esophageal Temperature Probe Location Evaluation Of Amplitude Eeg Supervisionof Controlled Hypothermia And Assessment Of Patient Tolerance Of Cooling
99188-CPT	Low	Application Of Topical Fluoride Varnish By A Physician Or Other Qualified Health Care Professional
99202-CPT	Low	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99203-CPT	Low	Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99202. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99202 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99202) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo

CPT 99202 Fee Schedule

Want to see your competitors' rates?

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Prospect for new business using fee schedules

Integrate real-time payer data into your workflows

Let's review your payer contracts side-by-side with the market.

Frequently Asked Questions

How can I find out the cost of a medical procedure?

What is a CPT code and how does it relate to medical billing?

Where can I find information about Medicare or Medicaid reimbursement rates?

How do I understand my medical bill?

What is the difference between an allowed amount, a billed amount, and what I actually pay?