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99205 is a CPT code for: Office or other outpatient visit for the evaluation and management of a new patient with a comprehensive history and examination, and medical decision making of high complexity.

This level of service is the highest of 5 levels. A physician encountering a patient with a disease of high severity such as Hepatitis B would typically or most likely provide complex treatment and care, thus warranting the use of this level 5 code.

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15y ago

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Procedure code 99205 refers to a Level 5 (the highest level) New Patient office visit. I am on this page myself because I have just been denied a claim to my insurance company from an office that used this code. The insurance company claims that the code is "unlisted," while the doctor's office insists that this is the only new patient code they ever use.Our system is so, so broken.Best of luck.


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Procedure code 99205 is used for a new patient office or other outpatient visit that requires a comprehensive evaluation and management (E/M) service. This code is typically applicable when the visit involves a high level of complexity, with a total of at least 60 minutes of time spent on the encounter. It includes a detailed history, examination, and medical decision-making of high complexity. This code is part of the Current Procedural Terminology (CPT) system, reflecting the requirements set by the American Medical Association (AMA).


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