| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $72.26 |
| Typical Billed Amount What providers commonly charge | $110 – $220 |
| Potential Markup How much more you might pay vs. Medicare rate | 204% above Medicare |
What CPT 99202 Means for Your Visit
When you see a doctor for the first time, they use CPT code 99202 to bill for visits involving straightforward medical issues. This might include routine check-ups, simple concerns like minor skin conditions, or follow-ups for stable chronic conditions that don't require extensive evaluation.
During a 99202 visit, your doctor will typically spend 15-29 minutes with you, taking your medical history, performing a basic examination, and making straightforward medical decisions about your care. These visits are less complex than those requiring extensive testing, multiple treatment options, or complicated diagnoses.
This code is specifically for new patients, meaning you haven't seen this particular doctor (or anyone in their practice group) within the past three years. If you're an established patient, your doctor would use a different billing code for similar services.
What to Expect on Your Medical Bill
When you receive your medical bill or explanation of benefits, you'll see CPT code 99202 listed for your new patient visit. The typical charge for this service ranges from $110 to $220, depending on your healthcare provider and geographic location.
If you have Medicare, the standard reimbursement rate for this code is $72.26, though you may see different amounts based on your specific coverage and deductibles. Private insurance companies negotiate their own rates with healthcare providers, so your actual out-of-pocket cost will depend on your insurance plan's coverage and whether you've met your deductible.
You should expect to see this code billed only once per visit, and it should correspond to a new patient appointment you actually attended. The date of service on your bill should match when you had your appointment.
How to Verify Your Bill Is Correct
To check if your 99202 billing is accurate, first confirm that you were indeed a new patient at the time of your visit. Remember, you're considered new if you haven't seen that specific doctor or anyone in their practice within three years. If you were an established patient, the correct code should be 99212 instead.
Next, verify that the charge falls within the typical range of $110-$220. If the amount seems unusually high, contact your healthcare provider's billing department to ask for an itemized explanation. Sometimes additional services performed during your visit may result in separate charges.
If you believe you've been incorrectly billed, gather your appointment records and contact your healthcare provider's billing office first. They can review your visit notes and explain the charges. If you're still not satisfied with the explanation, you can contact your insurance company to request a review of the claim. Keep detailed records of all communications regarding billing disputes.