CPT 99202 Fee Schedule

Last Verified: November 2025

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	Moderate

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	$68.50	1134264740 - MICHEL KAHALEH	753068151 - (MS) MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI INC	NJ	Gastroenterology Physician (207RG0100X)
United	99202	$96.66	1568696300 - VIRENDRA TEWARI	264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C	NY	Gastroenterology Physician (207RG0100X)
United	99202	$112.25	1467604447 - AVA ANKLESARIA	135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	NY	Gastroenterology Physician (207RG0100X)
United	99202	$64.12	1124094024 - CRISTINA LOPEZ-PENALVER	205155995	FL	Surgery Physician (208600000X)
United	99202	$165.00	1740459676 - DONNA POWELL	811291017 - (FL) WOMENS HEALTH HOSPITALISTS LLC	FL	Gastroenterology Physician (207RG0100X)
United	99202	$62.20	1013992528 - ROM GUPTA	113541778 - (NY) DIGESTIVE DISEASES & NUTRITION, LLC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$97.08	1205940939 - PERRY GOULD	844279391 - (NY) MEDICAL SERVICES OF UNIONDALE PC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$55.70	1053550079 - FREDERICK GANDOLFO	823209354 - (NY) PRECISION DIGESTIVE CARE PC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$68.04	1972510535 - ANGELA KELEHER	237313346 - (FL) UNIVERSITY MEDICAL SERVICE ASSOCIATION INC	FL	Surgery Physician (208600000X)
United	99202	$68.00	1184624355 - MICHAEL TINDEL	201134816 - (TX) LEGACY PHYSIATRY GROUP, LLC	FL	Gastroenterology Physician (207RG0100X)
United	99202	$69.94	1831552165 - KEVIN YEROUSHALMI	113465690	NY	Gastroenterology Physician (207RG0100X)
United	99202	$104.31	1609827914 - JOSHUA SOMERSET	591641854 - (FL) STOCKWELL, REISMAN, PAULK & TAYLOR, P.A.	FL	Gastroenterology Physician (207RG0100X)
United	99202	$68.00	1033178223 - SINDHU ABRAHAM	752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS	TX	Gastroenterology Physician (207RG0100X)
United	99202	$86.31	1285615823 - MICHAEL STECKMAN	475030523 - NORTHERN MEDICAL GROUP, PLLC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$63.77	1164735072 - ALEXANDER BRUN	474035304 - (NY) TRIBOROUGH GI PLLC	NY	Gastroenterology Physician (207RG0100X)
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

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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	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	Low	Application Of Topical Fluoride Varnish By A Physician Or Other Qualified Health Care Professional
99202	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	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.

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