99205 Office outpatient new hi 60 minutes
Also known as: complex office visit, comprehensive follow-up, high complexity visit, new patient office visit level 5, high complexity new visit
Office or other outpatient visit for the evaluation and management of an established patient with high medical decision-making complexity and an expected duration of 60 minutes.
In Plain Language
Long, detailed doctor's visit; Complex medical appointment
Clinical Context
Used for established patient visits involving high complexity medical decision-making, such as management of multiple acute and chronic conditions with complex diagnostic and therapeutic planning.
RVU Breakdown
| Work RVU | 3.50 |
| Total RVU | 3.50 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 3.50, this code ranks in the 88th percentile among Evaluation & Management codes — 2.3x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99205?
CPT 99205 (Office outpatient new hi 60 minutes) is a Evaluation & Management code. Office or other outpatient visit for the evaluation and management of an established patient with high medical decision-making complexity and an expected duration of 60 minutes.
Who uses CPT code 99205?
CPT 99205 is used by Family Medicine, Internal Medicine, Subspecialties. Used for established patient visits involving high complexity medical decision-making, such as management of multiple acute and chronic conditions with complex diagnostic and therapeutic planning.
When is CPT 99205 used?
Used for established patient visits involving high complexity medical decision-making, such as management of multiple acute and chronic conditions with complex diagnostic and therapeutic planning.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.