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CMS RVU26D · Effective 2026-10-01

99202 in Redding

Office / nonfacility

$78.60

Base rate per service

Facility setting

$41.26

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Evaluation and management

About 99202: New patient office visit, straightforward decision making

Lowest-level office or outpatient visit for a new patient, reported when medical decision making is straightforward or total practitioner time reaches 15 minutes.

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.

Where the value comes from

  • Work RVU0.93 · 41%
  • Practice expense (office) RVU1.25 · 56%
  • Malpractice RVU0.07 · 3%

832.9K

Medicare services in 2024 · #163 by national volume

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.

99202 compared with similar codes

Office rates for Redding, from the same CMS release.

99212

Office visit

Established patient, straightforward

$62.19

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.

99203

New patient visit

Low MDM or 30 minutes

$121.64

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.

99211

Office visit

Established patient, minimal E/M

$26.06

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.

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 99202 is $78.84—$0.24 higher than the $78.60 rate in Redding. Both use the same code, release and participation basis.

99202 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $78.60

  2. Bakersfield

    $78.84

    $0.24 higher than Redding

  3. Chico

    $78.60

    The same base rate than Redding

  4. El Centro

    $78.62

    $0.02 higher than Redding

  5. Fresno

    $78.60

    The same base rate than Redding

  6. Hanford-Corcoran

    $78.60

    The same base rate than Redding

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $83.28

    $4.68 higher than Redding

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 99202 ranges from $68.13 in Arkansas to $95.94 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Merced

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Modesto

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Napa

    California · 99202

    Office

    $89.24

    Facility

    $44.33

    $10.64 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 99202

    Office

    $82.74

    Facility

    $42.47

    $4.14 higher than Redding for the office setting.

  • Rest Of California

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 99202

    Office

    $79.38

    Facility

    $42.04

    $0.78 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 99202

    Office

    $81.99

    Facility

    $42.37

    $3.39 higher than Redding for the office setting.

  • Salinas

    California · 99202

    Office

    $81.67

    Facility

    $42.18

    $3.07 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 99202

    Office

    $83.20

    Facility

    $42.45

    $4.60 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 99202

    Office

    $93.96

    Facility

    $45.92

    $15.36 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 99202

    Office

    $93.88

    Facility

    $45.84

    $15.28 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 99202

    Office

    $95.94

    Facility

    $46.81

    $17.34 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 99202

    Office

    $95.61

    Facility

    $46.49

    $17.01 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 99202

    Office

    $80.40

    Facility

    $41.59

    $1.80 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 99202

    Office

    $83.70

    Facility

    $42.30

    $5.10 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 99202

    Office

    $81.87

    Facility

    $42.14

    $3.27 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 99202

    Office

    $84.52

    Facility

    $42.68

    $5.92 higher than Redding for the office setting.

  • Stockton

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 99202

    Office

    $89.12

    Facility

    $44.22

    $10.52 higher than Redding for the office setting.

  • Visalia

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 99202

    Office

    $78.60

    Facility

    $41.26

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 99202

    Office

    $84.53

    Facility

    $44.39

    $5.93 higher than Redding for the office setting.

  • Miami

    Florida · 99202

    Office

    $80.44

    Facility

    $44.97

    $1.84 higher than Redding for the office setting.

  • Chicago

    Illinois · 99202

    Office

    $78.61

    Facility

    $44.37

    $0.01 higher than Redding for the office setting.

  • Manhattan

    New York · 99202

    Office

    $85.27

    Facility

    $45.69

    $6.67 higher than Redding for the office setting.

  • Alaska*

    Alaska · 99202

    Office

    $92.35

    Facility

    $56.06

    $13.75 higher than Redding for the office setting.

  • Alabama

    Alabama · 99202

    Office

    $68.92

    Facility

    $39.11

    $9.68 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 99202

    Office

    $68.13

    Facility

    $38.87

    $10.47 lower than Redding for the office setting.

  • Arizona

    Arizona · 99202

    Office

    $73.52

    Facility

    $40.51

    $5.08 lower than Redding for the office setting.

  • Colorado

    Colorado · 99202

    Office

    $77.68

    Facility

    $41.44

    $0.92 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 99202

    Office

    $79.48

    Facility

    $42.79

    $0.88 higher than Redding for the office setting.

  • Delaware

    Delaware · 99202

    Office

    $74.57

    Facility

    $40.91

    $4.03 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 99202

    Office

    $77.58

    Facility

    $43.07

    $1.02 lower than Redding for the office setting.

  • Rest Of Florida

    Florida · 99202

    Office

    $74.49

    Facility

    $41.92

    $4.11 lower than Redding for the office setting.

  • Atlanta

    Georgia · 99202

    Office

    $76.38

    Facility

    $41.77

    $2.22 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 99202

    Office

    $71.09

    Facility

    $40.70

    $7.51 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 99202

    Office

    $79.89

    Facility

    $41.15

    $1.29 higher than Redding for the office setting.

  • Iowa

    Iowa · 99202

    Office

    $70.19

    Facility

    $39.02

    $8.41 lower than Redding for the office setting.

  • Idaho

    Idaho · 99202

    Office

    $70.58

    Facility

    $39.24

    $8.02 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 99202

    Office

    $74.18

    Facility

    $42.84

    $4.42 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 99202

    Office

    $72.84

    Facility

    $41.73

    $5.76 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 99202

    Office

    $78.30

    Facility

    $43.31

    $0.30 lower than Redding for the office setting.

  • Indiana

    Indiana · 99202

    Office

    $70.90

    Facility

    $39.32

    $7.70 lower than Redding for the office setting.

  • Kansas

    Kansas · 99202

    Office

    $69.98

    Facility

    $39.19

    $8.62 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 99202

    Office

    $70.32

    Facility

    $40.03

    $8.28 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 99202

    Office

    $73.01

    Facility

    $40.95

    $5.59 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 99202

    Office

    $70.25

    Facility

    $40.10

    $8.35 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 99202

    Office

    $84.27

    Facility

    $43.59

    $5.67 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 99202

    Office

    $77.39

    Facility

    $41.51

    $1.21 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 99202

    Office

    $79.25

    Facility

    $42.70

    $0.65 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 99202

    Office

    $75.77

    Facility

    $41.29

    $2.83 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 99202

    Office

    $70.93

    Facility

    $39.58

    $7.67 lower than Redding for the office setting.

  • Southern Maine

    Maine · 99202

    Office

    $73.91

    Facility

    $40.15

    $4.69 lower than Redding for the office setting.

  • Detroit

    Michigan · 99202

    Office

    $75.29

    Facility

    $42.42

    $3.31 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 99202

    Office

    $71.82

    Facility

    $40.72

    $6.78 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 99202

    Office

    $74.72

    Facility

    $39.66

    $3.88 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 99202

    Office

    $72.55

    Facility

    $40.56

    $6.05 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 99202

    Office

    $73.15

    Facility

    $40.72

    $5.45 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 99202

    Office

    $69.33

    Facility

    $39.96

    $9.27 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 99202

    Office

    $68.74

    Facility

    $39.41

    $9.86 lower than Redding for the office setting.

  • Montana**

    Montana · 99202

    Office

    $75.15

    Facility

    $41.08

    $3.45 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 99202

    Office

    $71.51

    Facility

    $39.72

    $7.09 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 99202

    Office

    $73.76

    Facility

    $39.69

    $4.84 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 99202

    Office

    $70.48

    Facility

    $39.04

    $8.12 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 99202

    Office

    $76.57

    Facility

    $41.11

    $2.03 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 99202

    Office

    $83.95

    Facility

    $44.43

    $5.35 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 99202

    Office

    $80.46

    Facility

    $43.26

    $1.86 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 99202

    Office

    $72.16

    Facility

    $40.92

    $6.44 lower than Redding for the office setting.

  • Nevada**

    Nevada · 99202

    Office

    $74.80

    Facility

    $40.70

    $3.80 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 99202

    Office

    $87.03

    Facility

    $46.53

    $8.43 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 99202

    Office

    $81.01

    Facility

    $43.70

    $2.41 higher than Redding for the office setting.

  • Queens

    New York · 99202

    Office

    $85.77

    Facility

    $45.50

    $7.17 higher than Redding for the office setting.

  • Rest Of New York

    New York · 99202

    Office

    $72.37

    Facility

    $40.00

    $6.23 lower than Redding for the office setting.

  • Ohio

    Ohio · 99202

    Office

    $71.54

    Facility

    $40.43

    $7.06 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 99202

    Office

    $70.16

    Facility

    $39.74

    $8.44 lower than Redding for the office setting.

  • Portland

    Oregon · 99202

    Office

    $79.68

    Facility

    $41.83

    $1.08 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 99202

    Office

    $74.29

    Facility

    $40.36

    $4.31 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 99202

    Office

    $77.87

    Facility

    $42.41

    $0.73 lower than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 99202

    Office

    $71.60

    Facility

    $40.32

    $7.00 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 99202

    Office

    $75.58

    Facility

    $41.13

    $3.02 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 99202

    Office

    $76.87

    Facility

    $41.67

    $1.73 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 99202

    Office

    $71.63

    Facility

    $40.15

    $6.97 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 99202

    Office

    $73.60

    Facility

    $39.53

    $5.00 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 99202

    Office

    $70.27

    Facility

    $39.30

    $8.33 lower than Redding for the office setting.

  • Austin

    Texas · 99202

    Office

    $77.37

    Facility

    $41.32

    $1.23 lower than Redding for the office setting.

  • Beaumont

    Texas · 99202

    Office

    $71.23

    Facility

    $40.23

    $7.37 lower than Redding for the office setting.

  • Brazoria

    Texas · 99202

    Office

    $74.51

    Facility

    $40.75

    $4.09 lower than Redding for the office setting.

  • Dallas

    Texas · 99202

    Office

    $74.93

    Facility

    $41.00

    $3.67 lower than Redding for the office setting.

  • Fort Worth

    Texas · 99202

    Office

    $74.55

    Facility

    $40.95

    $4.05 lower than Redding for the office setting.

  • Galveston

    Texas · 99202

    Office

    $74.71

    Facility

    $40.88

    $3.89 lower than Redding for the office setting.

  • Houston

    Texas · 99202

    Office

    $75.99

    Facility

    $42.16

    $2.61 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · 99202

    Office

    $72.80

    Facility

    $40.46

    $5.80 lower than Redding for the office setting.

  • Utah

    Utah · 99202

    Office

    $72.41

    Facility

    $40.38

    $6.19 lower than Redding for the office setting.

  • Virginia

    Virginia · 99202

    Office

    $73.75

    Facility

    $40.27

    $4.85 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 99202

    Office

    $75.58

    Facility

    $41.13

    $3.02 lower than Redding for the office setting.

  • Vermont

    Vermont · 99202

    Office

    $73.58

    Facility

    $39.85

    $5.02 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 99202

    Office

    $77.21

    Facility

    $41.34

    $1.39 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 99202

    Office

    $85.75

    Facility

    $43.95

    $7.15 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 99202

    Office

    $71.78

    Facility

    $39.14

    $6.82 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 99202

    Office

    $70.69

    Facility

    $41.08

    $7.91 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 99202

    Office

    $74.54

    Facility

    $40.48

    $4.06 lower than Redding for the office setting.

See how rates vary across the country

99202 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$68.13

$92.35

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$92.351
AL$68.921
AR$68.131
AZ$73.521
CA$78.60–$95.9429
CO$77.681
CT$79.481
DC$84.531
DE$74.571
FL$74.49–$80.443
GA$71.09–$76.382
GU$79.891
HI$79.891
IA$70.191
ID$70.581
IL$72.84–$78.614
IN$70.901
KS$69.981
KY$70.321
LA$70.25–$73.012
MA$77.39–$84.272
MD$75.77–$84.533
ME$70.93–$73.912
MI$71.82–$75.292
MN$74.721
MO$69.33–$73.153
MS$68.741
MT$75.151
NC$71.511
ND$73.761
NE$70.481
NH$76.571
NJ$80.46–$83.952
NM$72.161
NV$74.801
NY$72.37–$87.035
OH$71.541
OK$70.161
OR$74.29–$79.682
PA$71.60–$77.872
PR$75.581
RI$76.871
SC$71.631
SD$73.601
TN$70.271
TX$71.23–$77.378
UT$72.411
VA$73.75–$84.532
VI$75.581
VT$73.581
WA$77.21–$85.752
WI$71.781
WV$70.691
WY$74.541

Explore 99202 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 99202 in Redding, the physician’s office rate is $78.60 and the facility-setting rate is $41.26: a difference of $37.34.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 99202 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$86.46

$78.60 × 110% = $86.46

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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Primary care

Compare office and outpatient evaluation-and-management base rates.

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99202 in Redding.

PPRRVU2026_Oct_nonQPP.csv

13,009

Code
99202
Physician work
0.93
Practice expense
1.25
Malpractice
0.07

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 99202 in Redding
ComponentRVULocality factorAdjusted
Physician work0.93× 1.0170.9458
Practice expense1.25× 1.0961.3700
Malpractice0.07× 0.5360.0375
Total RVUs2.3533
Conversion factor× 33.4009

Office / nonfacility rate, Redding$78.60

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 99202 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.931.017
Practice expense1.251.096
Malpractice0.070.536

(0.93 × 1.017 + 1.25 × 1.096 + 0.07 × 0.536) × $33.4009 = $78.60

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.931.017
Practice expense0.231.096
Malpractice0.070.536

(0.93 × 1.017 + 0.23 × 1.096 + 0.07 × 0.536) × $33.4009 = $41.26

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

99202 · Office / nonfacility

$78.60

Effective 2026-10-01

The base rate is $5.82 higher than on 2025-10-01, moving from $72.78 to $78.60 (8.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $72.78changed to$78.60

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.16 changed to 1.25
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $72.78

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$78.60$41.26RVU26D
2026-07-01$78.60$41.26RVU26C
2026-04-01$78.60$41.26RVU26B
2026-01-01$78.60$41.26RVU26A
2025-10-01$72.78$45.91RVU25D
2025-07-01$72.78$45.91RVU25C
2025-04-01$72.78$45.91RVU25B
2025-01-01$72.78$45.91RVU25A

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.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 99202PPRRVU2026_Oct_nonQPP.csv, line 13,009 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet