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CPT® 99205 in section: New Patient Office or Other Outpatient Services...
CPT® Code Set
99205 - CPT® Code in category: New Patient Office or Other Outpatient Services...
CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA.
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CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA.
Additional Code Information includes:
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Save time with a Professional or Facility subscription! You will be able to see the most common modifiers billed to Medicare along with this code.
Related CPT CodeBook Guidelines (Reverse Guideline Lookup) 
cpt/cpt_reference_guidelines_content.php?set=CPT&c=99205
View historical information about the code including when it was added, changed, deleted, etc. Access to this feature is available in the following products:
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CPT® Vignettes illustrate code use through sample patient examples. Every vignette contains a Clinical Example/Typical Patient and a description of Procedure/Intra-service. Where appropriate, there are also Pre- and Post-service descriptions. Vignettes are reviewed annually and updated when necessary. 300-400 new vignettes are added each year as codes added, revised and reviewed. Available for over 5000 of the most common CPT codes. Access to this feature is available in the following products:
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Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Access to this feature is available in the following products:
Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. |
Effective January 1, 2014, CMS wants providers to use G0463 for payment under the OPPS for
outpatient hospital clinic visits. Do not use codes 99201-99205 or 99211-99215 for payment under the OPPS.
For more details, see https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm8572.pdf.
See Documentation, coding, and billing tips for this code. Access to this feature is available in the following products:
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* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.
Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|---|---|---|---|
| (none) | $179.75 | $269.63 | $359.51 | (your fee) |
Calculated fee values are available. Access to this feature is available in the following products:
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Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays |
|---|---|---|---|
| (none) | $179.75 | $##.## | $##.## |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|---|---|---|---|
| (none) | $220.36 | $330.54 | $440.73 | (your fee) |
View calculated CPT fee values specifically for your Medicare locality. Access to this feature is available in the following products:
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Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays |
|---|---|---|---|
| (none) | $220.36 | $##.## | $##.## |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
This section shows APC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. Access to this feature is available in the following products:
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View fees for this code from 4 different built-in fee schedules and from those you've added using the Compare-A-Fee™ tool. If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Fee™ tool.
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View a table of UCR, Worker's Comp, and Medicare Fees here, as well as see UCR Fees in the charts below. Access to this feature is available in the following products:
Note: Subscribers will see the fee graphs below. |
View a chart showing the last 8+ years of Medicare denial rates, Medicare Allowed amounts, and Medicare billed amounts. Access to this feature is available in the following products:
Note: Subscribers will see the fee graphs below. |
* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|---|---|---|---|
| (none) | 3.5 | 1.57 | 0.33 | 5.400 |
Calculated fee values are available. Access to this feature is available in the following products:
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| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|---|---|---|
| ## | ## | ## | ## min |
| Modifier | National Unadjusted Work RVU | Work GPCI | Adjusted Work RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 3.5 |
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time |
|---|---|---|---|---|---|
| RN/LPN/MTA | $0.50 / min | ## min | ## min | ## min | ## min |
| Item | Purchase Price | Expected Life | Total Time |
|---|---|---|---|
| table, exam | $##.## | ## years | ## min |
| Portable stand-on scale | $##.## | ## years | ## min |
| otoscope-ophthalmoscope (wall unit) | $##.## | ## years | ## min |
| Item | Unit Price | Quantity | Unit | Amount |
|---|---|---|---|---|
| pack, EM visit | $##.## | ## | pack | $##.## |
| sanitizing cloth-wipe (surface, instruments, equipment) | $##.## | ## | item | $##.## |
| Modifier | National Unadjusted PE RVU | PE GPCI | Adjusted PE RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 1.570 |
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|---|---|---|---|
| (none) | 3.5 | 2.79 | 0.33 | 6.620 |
View calculated CPT fee values specifically for your Medicare locality. Access to this feature is available in the following products:
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| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|---|---|---|
| ## | ## | ## | ## min |
| Modifier | National Unadjusted Work RVU | Work GPCI | Adjusted Work RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 3.5 |
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time |
|---|---|---|---|---|---|
| RN/LPN/MTA | $0.50 / min | ## min | ## min | ## min | ## min |
| Item | Purchase Price | Expected Life | Total Time |
|---|---|---|---|
| table, exam | $##.## | ## years | ## min |
| Portable stand-on scale | $##.## | ## years | ## min |
| otoscope-ophthalmoscope (wall unit) | $##.## | ## years | ## min |
| Item | Unit Price | Quantity | Unit | Amount |
|---|---|---|---|---|
| pack, EM visit | $##.## | ## | pack | $##.## |
| sanitizing cloth-wipe (surface, instruments, equipment) | $##.## | ## | item | $##.## |
| Modifier | National Unadjusted PE RVU | PE GPCI | Adjusted PE RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 2.790 |
View relationships (or crosswalks) between code sets. Access to this feature is available in the following products:
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