What this is, in plain language
A first visit with a clinician you have not seen recently, lasting about 45–59 minutes of total provider time or involving moderate-complexity decision-making.
Why a clinician orders it
Establishing care or evaluating a new problem with multiple data points to review.
Medical necessity — what insurers usually look at
Usually covered with a copay or coinsurance. New patient codes are billable only if you have not been seen by that provider (or any provider of the same specialty in the group) within the past three years.
Documentation to ask about
- ✓Reason for establishing care
- ✓Outside records reviewed
- ✓Total time or MDM elements
Questions for your provider
- ?Is the provider in-network for my plan?
- ?Will any labs ordered today be sent to an in-network lab?
Why this code is in our seed set
Top new-patient E/M code in the CMS Top 200; commonly the highest-volume new-patient code in primary care and specialty office settings.
Validated against
- •AMA CPT code 99204 descriptor (2021 E/M revision)
- •CMS Top 200 Level I CPT Codes Ranked by Services
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.