CPT Code 99202: Billing Guidelines, Documentation Tips, and Reimbursement Insights

In this quick reference guide to CPT code 99202, we answer frequently asked questions from our community of chiropractors. Follow us for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors.

CPT code 99202 is commonly used for low-complexity, new-patient evaluation and management (E/M) visits. Billers and providers often struggle with correct documentation, time-based coding, and determining whether the encounter meets the requirements for this level of service. This guide explains when 99202 is appropriate, what documentation supports it, how it differs from adjacent E/M codes, and how to avoid common billing errors that lead to denials.

What Is CPT Code 99202?

CPT 99202 is used for new patient office or outpatient visits that involve evaluation and management (E/M) services at a straightforward level of complexity. In plain English: This code applies to new patients who need a basic assessment—not an in-depth workup, but more than a quick check-in.

Key Points

• New patient: Someone who hasn’t seen you (or another chiropractor in your group) in the last three years.
• Straightforward decision-making: The visit involves simple clinical decisions—minor symptoms, no major risks, and no complex data review.
• Time: You can base your coding on time or the complexity of your medical decision-making, whichever is more appropriate for the visit.

When Should Chiropractors Use 99202?

Use CPT 99202 for new patient visits when:

• You gather a medically appropriate history and perform a relevant exam (no need for exhaustive detail—just what’s necessary for the patient’s complaint).
• Your decision-making is straightforward. For example, you’re diagnosing a minor issue or developing a simple treatment plan.
• The visit duration is at least 15 minutes.

When NOT to Use 99202

Choose a different code if:

• The patient is already established (seen by you or your group in the last three years). Use 99212–99215 for those visits.
• You’re only providing chiropractic manipulative treatment (CMT). Bill CMT codes (98940–98942) separately.
• The visit takes 30 minutes or more. Use a higher-level code (such as 99203, which starts at 30 minutes), provided the complexity and other requirements are met.
• The visit is dominated by counseling or education. If over half the visit is spent on counseling, you may still use 99202, but document the time and content clearly.

Common Modifiers with 99202

Modifiers clarify your billing and help ensure you get paid for all the work you do. Here are the most relevant ones:

• Modifier 25: Use this if you provide a significant, separately identifiable E/M service (like 99202) on the same day as a procedure (like CMT).
• Modifier 95 or GT: Use these for telehealth visits, depending on what your payer requires.

Note: Modifier AT is generally for CMT codes billed to Medicare, not for E/M codes like 99202. Modifier 59 is rarely used with E/M codes.

Documentation and Billing Guidelines

To bill 99202 correctly:

• Confirm the patient is new to your practice.
• Document a medically appropriate history and/or exam.
• Clearly show your clinical decision-making was straightforward.
• If you’re billing based on time, note the total time spent face-to-face with the patient.
• If you provide a separate procedure (like CMT), make sure your notes support the use of Modifier 25.

Common Mistakes to Avoid

• Using 99202 for established patients: This is a new patient code only.
• Over-documenting or under-documenting: Match your notes to the code’s requirements—don’t add unnecessary detail, but don’t skimp either.
• Relying only on time: Make sure the complexity of your decision-making also supports your code choice.
• Ignoring payer guidelines: Double-check each insurer’s requirements, especially for telehealth or modifier use.

Audit Triggers for 99202

Avoid these red flags:

• Billing 99202 for every new patient, regardless of complexity.
• Incomplete or vague documentation.
• Using 99202 when your notes show more (or less) complexity than the code requires.
• Billing for bundled services without proper modifiers.

Best Practices for Efficient, Accurate Billing

• Audit your charts regularly to catch errors before they become problems.
• Stay up-to-date with coding changes and payer policies.
• Use chiropractic-specific EHR and billing software (like ChiroTouch) to streamline your workflow.

The Bottom Line

 Use CPT 99202 for new patient visits with straightforward needs. Document clearly, use modifiers wisely, and always check payer rules. With these habits, you’ll bill confidently, get reimbursed fairly, and keep your practice running smoothly.

Code with Confidence. Bill with Accuracy.

CPT codes are the foundation of successful chiropractic billing—but even minor mistakes can lead to denied claims, delayed payments, and lost revenue. Staying accurate and compliant takes more than a list of codes; you need the right system to support your team every step of the way.

‍ChiroTouch Cloud makes it easy.

‍With built-in chiropractic-specific templates, real-time claim tracking, and automated billing workflows, ChiroTouch helps you code accurately, submit clean claims, and get paid faster—all while reducing the administrative burden on your staff.

‍Book a demo today to see how ChiroTouch simplifies billing to maximize revenue.
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Used with permission of the American Medical Association. AMA CPT Professional 2024 Edition E/M Guidelines Code 99202, pg. 15. New Patient Office or Other Outpatient Services, Level 2.  

Copyright American Medical Association 2023. All rights reserved.