CPT code 99202: New patient visit, straightforward MDM or 15 minutes2026 Medicare rate & RVUs in Maine
Lowest-level office or outpatient visit for a new patient, reported when medical decision making is straightforward or total practitioner time reaches 15 minutes.
Medicare pays $70.93–$73.91 for 99202 in the office in Maine, from Rest of Maine to Southern Maine, ME. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Billing guides for 99202: G2211 add-on code
Where 99202 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest of Maine | $70.93 | $39.58 |
| Southern Maine, ME | $73.91 | $40.15 |
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.
How the rate is built · 99202
RVUs × geographic indexes × conversion factor
Work0.93
0.93 RVUs× 1.000 GPCI
Practice expense1.25
1.25 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
2.2500
Conversion factor
$33.4009
Medicare rate
$75.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99202
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$75.15
- Non-facility (office)
- $75.15
- Facility
- $41.08
Higher because the practice carries its own overhead.
99202 compared with similar codes
Compare codes · National
4 codes, side by side
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.
99202 billing questions
What makes a patient new for this code?
The patient has not received a professional service from the billing practitioner or another practitioner of the same specialty and subspecialty in the same group within the past three years. A patient previously seen by a different specialty in the group can still be new.
Is there a new patient equivalent of 99211 for nurse-only visits?
No. 99211 is limited to established patients, and 99202 is the lowest new patient office visit; it requires a physician or other qualified health care professional.
Whose time counts toward the 15 minutes?
Count the physician's or qualified practitioner's time on the encounter date, including chart review, examination, counseling, ordering, and documentation. Exclude time spent by medical assistants or nurses and time devoted to separately reported services.
When does a new patient visit need modifier 25?
Append modifier 25 when the visit is significant and separately identifiable from a minor procedure performed the same day, such as lesion destruction or a joint injection. Do not separately bill evaluation inherent to deciding on and performing that procedure.
Should 99202 or 99203 be reported for two minor problems?
Two or more self-limited or minor problems meet the low problem-complexity element, but low decision making requires a second element at the low level. If data and risk remain minimal, straightforward decision making may still support 99202.
99202 is in these specialty bundles: Primary care
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
Show the CMS file lines behind this rate
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