What this is, in plain language
A first visit with a clinician you have not seen recently, about 60–74 minutes of total provider time or high-complexity decision-making.
Why a clinician orders it
Complex new-patient evaluations — multiple serious conditions, extensive records, or high-risk medication decisions.
Medical necessity — what insurers usually look at
Covered with a copay or coinsurance, but insurers may audit frequent high-level new-patient billing. Documentation must support the time or complexity billed.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓Problems addressed and their severity
- ✓Records and data reviewed
- ✓Total time or MDM elements
Questions for your provider
- ?Is the provider in-network for my plan?
- ?Will anything today be billed separately?
Why this code is in our seed set
Highest-level new-patient office visit code; included in the CMS Top 200 Ranked by Services.
Validated against
- •AMA CPT code 99205 descriptor (2021 E/M revision)
- •CMS Top 200 Level I CPT Codes Ranked by Services
Terms you'll see
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
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.