$62.97
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.
On this page
CMS RVU26D · Effective 2026-10-01
99202 New patient visit Medicare reimbursement rates in Connecticut
Lowest-level office or outpatient visit for a new patient, reported when medical decision making is straightforward or total practitioner time reaches 15 minutes. Compare 99202 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 99202 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$79.48
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$42.79
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Connecticut, from the same CMS release.
$124.29
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.
$25.96
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.
Compare 99202 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$79.48
Facility
$42.79
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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 Connecticut.
PPRRVU2026_Oct_nonQPP.csv
13,009
- Code
- 99202
- Physician work
- 0.93
- Practice expense
- 1.25
- Malpractice
- 0.07
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.93 | × 1.020 | 0.9486 |
| Practice expense | 1.25 | × 1.077 | 1.3462 |
| Malpractice | 0.07 | × 1.210 | 0.0847 |
| Total RVUs | 2.3796 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$79.48
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.93 | 1.02 |
| Practice expense | 1.25 | 1.077 |
| Malpractice | 0.07 | 1.21 |
(0.93 × 1.02 + 1.25 × 1.077 + 0.07 × 1.21) × $33.4009 = $79.48
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.93 | 1.02 |
| Practice expense | 0.23 | 1.077 |
| Malpractice | 0.07 | 1.21 |
(0.93 × 1.02 + 0.23 × 1.077 + 0.07 × 1.21) × $33.4009 = $42.79
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.
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.
13,00699192,,Special pump services,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,00799195,,Phlebotomy,A,,0.00,2.89,,2.89,NA,0.05,2.94,2.94,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,00899199,,Unlisted special svc px/rprt,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,00999202,,Office o/p new sf 15 min,A,,0.93,1.25,,0.23,,0.07,2.25,1.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01099203,,Office o/p new low 30 min,A,,1.60,1.76,,0.38,,0.16,3.52,2.14,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01199204,,Office o/p new mod 45 min,A,,2.60,2.47,,0.66,,0.24,5.31,3.50,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01299205,,Office o/p new hi 60 min,A,,3.50,3.23,,0.94,,0.36,7.09,4.80,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808