99201–99205 – New Patient Evaluation & Management (E/M)
These codes represent office or outpatient visits for new patients, meaning the patient has not been seen by the provider or same specialty group within the past three years.
Code Descriptions
- 99201 – Deleted (no longer in use after 2021)
- 99202 – Straightforward medical decision-making; ~15–29 minutes
- 99203 – Low complexity decision-making; ~30–44 minutes
- 99204 – Moderate complexity decision-making; ~45–59 minutes
- 99205 – High complexity decision-making; ~60–74 minutes
Applicable Modifiers
- Modifier 25 – Significant, separately identifiable E/M service on the same day as a procedure
- Modifier 24 – Unrelated E/M service during postoperative period
- Modifier 57 – Decision for surgery
- Modifier 95 – Synchronous telehealth service
- Modifier 33 – Preventive services (if applicable)
- Modifier 52 – Reduced services
➤ 99211–99215 – Established Patient Evaluation & Management
These codes apply to established patients, meaning they have been seen within the last three years.
Code Descriptions
- 99211 – Minimal presenting problems; typically nurse-only visit
- 99212 – Straightforward decision-making; ~10–19 minutes
- 99213 – Low complexity; ~20–29 minutes
- 99214 – Moderate complexity; ~30–39 minutes
- 99215 – High complexity; ~40–54 minutes
Applicable Modifiers
- Modifier 25 – Separate E/M service on same day as procedure
- Modifier 24 – Unrelated E/M during postoperative period
- Modifier 95 – Telehealth visit
- Modifier 33 – Preventive service (if appropriate)
- Modifier 52 – Reduced services
➤ 99381–99387 – Preventive New Patient Visits
These codes represent preventive medicine evaluations for new patients, based on age, and include a full physical examination and risk assessment.
Code Descriptions
- 99381 – New patient preventive visit (Infant – Age 1)
- 99382 – Early childhood (Ages 1–4)
- 99383 – Late childhood (Ages 5–11)
- 99384 – Adolescent (Ages 12–17)
- 99385 – Young adult (Ages 18–39)
- 99386 – Adult (Ages 40–64)
- 99387 – Senior (Ages 65+)
Applicable Modifiers
- Modifier 25 – If a significant E/M sick visit is performed on the same day
- Modifier 33 – Preventive service modifier (most commonly used)
- Modifier 95 – Telehealth preventive visit (if payer allows)
➤ 99391–99397 – Preventive Established Patient Visits
These codes apply to established patients receiving age-appropriate preventive care and physical examinations.
Code Descriptions
- 99391 – Infant–Age 1 preventive visit
- 99392 – Ages 1–4
- 99393 – Ages 5–11
- 99394 – Ages 12–17
- 99395 – Ages 18–39
- 99396 – Ages 40–64
- 99397 – Ages 65+
Applicable Modifiers
- Modifier 25 – When a problem-oriented E/M is performed in addition to preventive visit
- Modifier 33 – Preventive services
- Modifier 95 – Telehealth (if supported)
