CPT code 99202: New patient visit, straightforward MDM or 15 minutes2026 Medicare rate & RVUs in Washington, DC area

In Washington, DC area, Medicare pays $84.53 for 99202 in the office and $44.39 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99202 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99202 covers

This visit covers a new-patient encounter when the patient has not received professional services from the physician or another physician or qualified practitioner of the same specialty and subspecialty in the same group within the past three years. An uncomplicated insect bite or simple upper respiratory complaint may involve the limited evaluation and treatment typical of this level; the visit level still depends on decision making or time. Physicians, nurse practitioners, physician assistants, and other qualified practitioners report it in offices, clinics, and hospital outpatient departments.

Select the level by medical decision making or total time. Straightforward decision making requires two of three elements: a self-limited or minor problem, minimal or no data, and minimal management risk. For time-based selection, the practitioner's combined face-to-face and non-face-to-face time on the date of service must meet or exceed 15 minutes; clinical staff time is excluded. Document the problem addressed and plan, along with the decision-making elements or total time supporting the level. A medically appropriate history and exam are documented but do not determine the level.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Washington, DC area compares for 99202

Across 109 of 109 payment localities, the office rate for 99202 runs from $68.13 in Arkansas to $95.94 in San Benito County, CA. Washington, DC area pays $84.53. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99202 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99202 in every payment locality

How the 99202 rate is calculated

Each of 99202’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99202

99202 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.

99202 compared with similar codes

Same family in Washington, DC area

How to choose

99212Office visitEstablished patient, straightforward

Both represent straightforward decision making, but 99212 applies to established patients seen within three years by the same practitioner or a same-specialty group member; 99202 is for new patients.

99203New patient visitLow MDM or 30 minutes

99203 requires low decision making based on two of three elements, or at least 30 minutes. 99202 requires straightforward decision making or at least 15 minutes.

99211Office visitEstablished patient, minimal E/M

99211 is an established patient visit that may not require a physician or qualified practitioner and is often nurse-performed. A new patient office visit begins at 99202 and requires a physician or qualified practitioner.

Codes related to 99202

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99202 has changed in Washington, DC area

Price 99202 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates