CPT® code 99204: New patient office or other outpatient visit, 45-59 minutes
As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. These codes, among the rest of the CPT code set, are clinically valid and updated on a regular basis to accurately reflect current clinical practice and innovation in medicine.
The clinical examples and their procedural descriptions, which reflect typical clinical situations found in the health care setting, are included in this text with many of the codes to provide practical situations for which the codes would be appropriately reported. It is important to note that these examples do not suggest limiting the use of a code instead, they are meant to represent the typical patient and service or procedure. In addition, they do not describe the universe of patients for whom the service or procedure would be appropriate.
Typical patient description
Office visit for a new patient with a progressing illness or acute injury that requires medical management or potential surgical treatment.
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 time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
About the CPT code set
Medical knowledge and science are constantly advancing, so the CPT Editorial Panel manages an extensive process to make sure the CPT code set advances with it. The Panel obtains broad input from practicing physicians and the health care community to ensure that the CPT code set reflects the coding demands of digital health, precision medicine, augmented intelligence and other aspects of a modern health care system. This rigorous process keeps the CPT code set current with contemporary medical science and technology, so it can fulfill its vital role as the language of medicine today and the code to its future.
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Disclaimer: Information provided by the AMA contained within this resource is for medical coding guidance purposes only. It does not (i) supersede or replace the AMA’s Current Procedural Terminology manual (“CPT® Manual”) or other coding authority, (ii) constitute clinical advice, (iii) address or dictate payer coverage or reimbursement policy, and (iv) substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.
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