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.

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

To get an estimate for the cost of a medical procedure, especially based on a specific CPT code and your location, you can utilize tools designed for this purpose. Payerprice offers a fee schedule lookup tool where you can search for procedure costs using CPT codes and your specific geographical area.

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

CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by healthcare providers, payers, and facilities to describe the medical, surgical, and diagnostic services provided to patients. They are essential for medical billing and reimbursement, ensuring that services are accurately documented and processed for payment.

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

For information on Medicare or Medicaid reimbursement rates, particularly for specific CPT codes in your area, Payerprice provides a fee schedule lookup tool. This tool allows users to search with CPT codes and specific locations to find relevant reimbursement data.

How do I understand my medical bill?

Understanding your medical bill involves reviewing several key components. Look for the date of service, the provider's name, the CPT codes for the services received, the billed amount, any adjustments or discounts, the amount paid by your insurance (if applicable), and your remaining patient responsibility. If you have questions about specific charges, it's best to contact your healthcare provider's billing department or your insurance company directly.

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

The 'billed amount' is the total amount your healthcare provider charges for a service before any insurance adjustments. The 'allowed amount' (or 'negotiated rate') is the maximum amount your insurance company will pay for a covered service, which is often a discounted rate agreed upon with providers. 'What you actually pay' is your out-of-pocket responsibility, which includes your deductible, copayments, and coinsurance, after the insurance company has paid its portion of the allowed amount.

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: October 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 O P New Sf 15 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded

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
Medicaid Fee Schedule	View Medicaid rates for 99202

National average reimbursement for CPT 99202 by major payers:

$83.09

$82.41

$80.62

$93.53

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 99202.

CPT 99202

5 of 25 sample ratesHigher to lower in this preview

Donna Powell
Womens Health Hospitalists LLC
FLGastroenterology PhysicianNPI 1740459676Tax ID 81-1291017
$165.00Published rate
Shavaun Johnson
Mental Health Specialty Group PA
MOPsychiatric/Mental Health Nurse PractitionerNPI 1225624729Tax ID 86-2493019
$84.51Published rate
Gina Mazzone
Mental Health Specialty Group PA
OHAddiction (Substance Use Disorder) CounselorNPI 1619352366Tax ID 86-2493019
$84.51Published rate
Kevin Yeroushalmi
NYGastroenterology PhysicianNPI 1831552165Tax ID 11-3465690
$69.94Published rate
Frank Ramharrack
Frank M Ramharrack Md PA
FLEndocrinology, Diabetes & Metabolism PhysicianNPI 1225017007Tax ID 59-3492235
$41.11Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

This code appears in 1 published specialty market.

Explore state-level rates by specialty

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
99202-CPT	Low	Office O P New Sf 15 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded
99203-CPT	Low	Office O P New Low 30 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And 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
99204-CPT	Moderate	Office O P New Mod 45 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And Or Examination And Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded
99205-CPT	High	Office O P New Hi 60 Min, 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 Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded

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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CPT 99202 Fee Schedule

Donna Powell

Shavaun Johnson

Gina Mazzone

Kevin Yeroushalmi

Frank Ramharrack