Code 99205 represents a new patient appointment that’s at least 60 minutes in duration.
December 9, 2024
11 min read
The 99205 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
Code 99205 represents a new patient appointment that’s at least 60 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99205 in the official CPT codebook:
CPT code 99205: New patient office visit, minimum 60 minutes
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.
As a prescriber, you can bill insurance according to time or medical decision-making (MDM). Make sure to include sufficient documentation to support the method you choose.
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
If you’re treating an existing patient, you should use 99215 instead. A new patient is someone you have not seen in the last three years.
Documentation for 99205 is essentially the same as other E/M codes, but geared toward a new patient.
In the example note below, the following factors are present, making 99205 the best code for billing the session:
Patient Name: Ravi Desai
Date of Service: 03/27/2023
Patient DOB: 11/27/1973
Appointment Time: 8:30am-9:30am
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
The total time I spent caring for this patient today was 73 minutes which included: interviewing the client, documenting, reviewing the patient's responses to questionnaires, discussing treatment plans, coordinating care, prescription management and counseling the client on managing her mental health.
Chief Complaint: Patient presents with severe anxiety, depression, and insomnia, expressing active suicidal ideation with a specific plan.
HPI: 50-year-old male with a history of major depressive disorder presents with worsening symptoms over the last 6 months. Reports frequent crying spells, loss of appetite, and insomnia. The patient states that he feels hopeless and has had frequent suicidal thoughts, including an active plan for overdose. Severe anxiety has led to avoidance of social situations and inability to work. He has had passive suicidal ideation in the past but recently formulated a plan, which increases the immediate risk.
General: Significant weight loss of 10 pounds in the past 3 months.
Neurological: Difficulty concentrating, no tremors.
Psychiatric: Depression, anxiety, and insomnia.
PMH/PSH:
Past medical history: Major Depressive Disorder, previously treated with Sertraline.
Past surgical history: None.
Medications: No current medications.
Allergies: No known drug allergies.
Substance Use Assessment: Denies tobacco and drug use, occasional alcohol use.
MSE:
Diagnosis:
PDMP Check:
The state’s PDMP was reviewed as required, and no concerning prescriptions were identified.
Risks and Benefits of Medication Adherence: The patient was thoroughly counseled on the risks and benefits of adhering to the prescribed medications, including the importance of regular use and potential side effects.
Risk: High risk due to active suicidal ideation with a specific plan and severe functional impairment.
Time spent: 60 minutes face-to-face.
Electronically signed by:
[Provider name, Credentials, Date signed]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Rationale: The client displays High number & complexity of problems with one chronic illness with severe exacerbation, No data reviewed, and High risk for current SI with plan and referral to inpatient/higher level-of-care.
Level of MDM: High
CPT Codes Selected: 99205
Reimbursement rates for sessions billed with 99205 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
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Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
Headway strives to simplify billing insurance so you can focus on providing care. Read our comprehensive guide to mental health billing.
Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
