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Procedure code 99205 refers to a Level 5 (the highest level) New Patient office visit. I am on this page myself because I have just been denied a claim to my insurance company from an office that used this code. The insurance company claims that the code is "unlisted," while the doctor's office insists that this is the only new patient code they ever use.

Our system is so, so broken.
Best of luck.

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15y ago

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What is the description for procedure code 99205?

Procedure code 99205 is used for a new patient office or other outpatient visit that requires a comprehensive evaluation and management (E/M) service. This code is typically applicable when the visit involves a high level of complexity, with a total of at least 60 minutes of time spent on the encounter. It includes a detailed history, examination, and medical decision-making of high complexity. This code is part of the Current Procedural Terminology (CPT) system, reflecting the requirements set by the American Medical Association (AMA).


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