New Patient CPT Codes: A Guide for 2024

April 22, 2024

New Patient CPT Codes: A Guide for 2024

It’s no secret that medical billing and coding are an alway-changing landscape, making it essential to keep up-to-date with the latest changes for the health of your practice.

The CPT (Current Procedural Terminology) codes related to new patients undergo updates once in a while, and these codes are vital for billing new patient consultations and treatments accurately…

That way, you get paid what you deserve. 

We’ll check out all the new patient CPT codes, including their updates for 2024, differences from established patient codes, and where to find expert help so that you can focus on your patients – not numbers and paperwork. 


Key Points:

  • New patient CPT code updates reflect changes in billing processes and compensation strategies, including modifications in time thresholds and complexity levels for coding to simplify the billing process.
  • New patient CPT codes are used for billing first-time consultations and services for patients who have not been seen by the provider or their practice group in the last three years. 
  • New patient codes are categorized into 5 different levels based on the complexity of the medical review and the time spent with the patient.


What Are New Patient CPT Codes?

New patient CPT codes are specific billing codes used by healthcare providers to bill for the first time consultations and services offered to patients who have not received any services from the provider or their practice group within the last three years. 

These codes are designed to compensate for the additional time and resources typically required to assess new patients.

Defining “Group Practice”

According to CPT, a group practice is a single entity with a single tax identification number, regardless of the number of locations or providers involved.

This means that multiple physicians can work collaboratively and share office space or administrative services, but they all have the same tax identification number.

Single-Specialty Practices

In a single-specialty practice, a patient is considered an established patient if any physician or provider who reports services under the same tax ID has seen the patient within the past three years. 

For example, if your partner in the same specialty saw a patient in the ED recently, you must use an established patient code for any subsequent visits within that time frame, even if there is no established medical record in your office.

Multi-specialty Practices

In a multi-specialty practice, a patient may be considered new if they have not seen a provider in the same specialty within the past three years. 

For example, if a patient has been seeing a pediatrician in your group and now wants to transfer care to a family physician in the same group, they will be considered a new patient for the family physician, even if the family physician is treating an existing problem and referring to the established medical record.

How To Use New Patient Codes When You Change Practices

When you join a new practice, you must use established patient codes for patients you have seen within the past three years, regardless of whether they have transferred their medical records to your new office. 

The time since your last encounter with the patient is the determining factor.

Medicare Patients

For Medicare patients, the definition of a new patient is limited to face-to-face encounters, and the group practice and specialty distinctions still apply. 

Therefore, if you see a Medicare patient within the past three years, you must report the service using an established patient code, but a new patient code can be used if a lab interpretation is billed with no face-to-face encounter.

Consultations vs. New Patient Visits

Consultations for opinions or advice are separate from new patient visits. 

CPT defines a consultation as a service provided by a physician whose opinion or advice is requested by another physician or appropriate source. 

The same consultation codes apply to both new and established patients, so there is no need to apply the new patient definition.

A patient and doctor facing each other sitting in chairs during a consultation.

2024 Updates to New Patient Codes

As of 2024, the updates to new patient CPT codes reflect changes aimed at simplifying billing processes and improving compensation for initial patient evaluations. 

These changes are part of a broader initiative to ensure that healthcare billing aligns more closely with the evolving needs of patient care and provider compensation strategies. 

Key updates include modifications in the time thresholds and complexity levels associated with different codes, where codes are now chosen based on the complexity of the visit and/or time. 

Differences Between New Patient Codes & Established Patient Codes

The primary difference lies in the eligibility of the patient. 

As mentioned, new patient codes are used when the patient has not been seen by the provider or their practice group within the last three years. 

Established patient codes are used when this condition does not apply. 

New patient codes often involve higher reimbursement rates to reflect the extra work involved in initial patient assessments.

Determining New or Established Patient Status

Here’s a decision tree that’ll help ensure accurate coding and billing:

  1. Has the patient seen a provider in the same tax ID within the past three years?
  • If yes, use an established patient code.
  • If no, proceed to the next question.
  1. Is the patient seeing a provider in the same specialty as their previous provider within the past three years?
  • If yes, use an established patient code.
  • If no, use a new patient code.

Levels of New Patient Codes

New patient CPT codes are categorized into different levels based on the complexity of the medical review and the amount of time spent with the patient. 

These levels help ensure that healthcare providers are adequately compensated for the time and effort required to assess new patients. 

There are 5 levels:

  • Level 1: For minimal complexity and brief visits.
  • Level 2: For low complexity and slightly longer visits.
  • Level 3: For moderate complexity.
  • Level 4: For high complexity, involving comprehensive assessments.
  • Level 5: Reserved for the most complex cases requiring extended consultation.

Each level corresponds to specific CPT codes, which are updated periodically to reflect current medical practice standards.

New Patient Codes Breakdown

Here’s a detailed look at the typical new patient CPT codes used in plastic surgery and dermatology:

CodeHistory/ExamMDMEncounter Time (minutes)Reimbursement Rate (2024)
99202Medically appropriate history and/or examinationStraightforward15-29$72.23
99203Medically appropriate history and/or examinationLow30-44$111.51
99204Medically appropriate history and/or examinationModerate45-59$167.10
99205Medically appropriate history and/or examinationHigh60-74$220.36
From CMS

  • 99201: This code is used for a brief visit that involves a straightforward problem evaluation.
  • 99202: Applies when the visit is for a low complexity problem.
  • 99203: Used for moderate complexity issues, involving more detailed examinations.
  • 99204: Corresponds to high complexity evaluations.
  • 99205: Used for the most complex evaluations requiring significant time and detailed patient interaction.

Where to Get Help with New Patient Codes

For healthcare providers in the fields of plastic surgery and dermatology, properly using new patient CPT codes is a must for financial success and operational efficiency.

This is where The Auctus Group excels. 

As an expert billing company specializing in these areas, The Auctus Group offers unmatched expertise and customer service. 

Our team ensures that every interaction is meaningful and informative, helping your practice thrive by optimizing your billing processes and enhancing overall operational efficiency.

Our services include:

  • detailed assessments of current billing practices
  • identification of areas for improvement
  • tailored solutions that align with the specific needs of plastic surgery and dermatology clinics 

Conclusion

Staying current with the latest updates in CPT codes, especially for new patients, can be a time-consuming but massively important task.

With the 2024 updates, it’s more important than ever for providers to understand these changes and adapt accordingly. 

Partnering with an expert like The Auctus Group allows you to focus on what matters – your patients – while we focus on the billing side of things.

That means no more billing and operational headaches!

FAQs

What is the CPT code for a new patient?  

CPT codes for new patients range from 99201 to 99205, depending on the complexity and length of the consultation. Each code corresponds to different levels of service complexity and time spent.

What is CPT code 99204 for a new patient?  

CPT code 99204 is used for new patients with moderate complexity medical issues. The visit usually involves a comprehensive history and examination, and the medical decision making of moderate complexity.

What is the difference between CPT code 99203 and 99204?  

The difference between CPT code 99203 and 99204 lies in the complexity and time. 99203 is used for visits of low complexity (30-44 minutes), while 99204 is used for moderate complexity (45-59 minutes).

What is the CPT code for a new patient physical?  

CPT code 99385 or 99387 is typically used for a new patient preventive physical exam, depending on the patient’s age and insurer.

What is the difference between CPT code 99214 and 99204?  

CPT code 99214 is for established patients with moderately complex issues (30-39 minutes), whereas 99204 is for new patients with moderate complexity (45-59 minutes).

When to bill 99213 vs 99214?  

Bill 99213 for established patients requiring a visit for a problem of moderate severity, and 99214 when the problem is more complex or the visit is longer, typically between 30-39 minutes.

What is considered a new patient?  

A new patient is one who has not received any professional services from the provider or another provider of the same specialty and same group practice within the past three years.

What are the 3 categories of CPT?  

CPT codes are divided into three categories: Category I (procedures and services), Category II (performance measurement and optional tracking), and Category III (emerging technology, services, and procedures).

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