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New Patient Visits & CPT Codes

You’re building your patient base and new patients are rolling in- So exciting! Here are some helpful tips for billing your office visits.

For billing office visits (or evaluation and management services), it’s generally a good idea to bill these visits at the first (new) patient evaluation and then every 30 days, or every sixth visit, after that. Just keep in mind that codes 97810, 97813, 97811, and 97814 already include evaluation and management as part of the overall treatment. So, you don’t need to bill them separately each time the patient receives acupuncture treatments.

New Patient Evaluation/Management (E/M) CPT codes consider complexity and time. It makes sense to bill differently for shorter, simpler evaluations versus longer, more complex ones. That’s how the E/M codes are structured, as you’ll see, next. 

Let’s look at CPT codes 99201 – 99205, used for New Patient visits:

CPT CodeHistory/Exam Medical Decision-Making (complexity)Presenting Problem (Severity)Face-to-Face
(Typical; Minutes) 
99201Problem-focusedStraightforwardSelf-Limited or Minor10
99202Expanded Problem-FocusedStraightforwardLow to Moderate20
99204ComprehensiveModerateModerate to High45
*New Patient E/M Criteria

Now, let’s look at CPT codes 99211 – 99214, used for Established Patient visits:

CPT CodeHistory/Exam Medical Decision-Making (complexity)Presenting Problem (Severity)Face-to-Face
(Typical; Minutes) 
99212Problem-FocusedStraightforwardSelf-Limited or Minor10
99213Expanded Problem-FocusedLowLow to Moderate15
99214DetailedModerateModerate to High25
99215ComprehensiveHighModerate to High40
*Established Patient E/M Criteria

Hope that makes things easier for you!

Stay well and happy, and thank you for reading! 🌼

Please check out my other posts on CPT codes, like CPT Codes and Their Importance for Acupuncturists, or CPT Codes: Charting is Everything for even more details about coding and billing.

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