99202 looks simple on paper. In practice, the harder part is knowing whether the patient, practitioner, payer, and documentation all line up before the code is used.
Can your practice bill 99202, or will the claim be denied before it reaches payment?
Billing code 99202 applies to certain new-patient office visits, yet it is not available to every practitioner or accepted by every payer. As a chiropractor, massage therapist, or other wellness provider, you need to confirm eligibility, patient status, documentation, time, and payer requirements before using the code.
This guide breaks down when 99202 applies, how it compares with similar codes, and what can cause a claim to be denied.
99202 billing code is used for certain new-patient office or outpatient visits. The encounter must involve straightforward decision-making or 15-29 minutes of qualifying practitioner time on the date of the visit.
Meeting the time or decision-making requirements does not automatically make 99202 billable. You should also be allowed to perform and report the services, in addition to the patient’s plan recognizing the code for that practitioner type.
Here’s what that means in practice:
| Question to check | What to verify |
|---|---|
| Is the service within the practitioner’s scope? | State licensing and scope-of-practice rules |
| Is the practitioner credentialed to report E/M services? | Payer enrollment and credentialing records |
| Does the payer recognize the practitioner type? | Commercial plan, Medicaid, workers’ compensation, or auto insurance policy |
| Does the patient’s plan cover the service? | Eligibility, benefits, exclusions, and visit limits |
| Is the visit separately reimbursable? | Bundling and same-day service rules |
| Are referral or authorization requirements met? | Payer policy and the patient’s plan |
| Does the documentation support 99202? | New-patient status, decision-making, time, and services performed |
| Will the practice bill directly or issue a superbill? | Network status and out-of-network reimbursement rules |
Treat this table as a set of billing checkpoints rather than a guarantee of payment. A practitioner may meet the clinical requirements for 99202 and still receive a denial because the plan excludes the service or requires a different billing arrangement.
See the official CMS Evaluation and Management Services guide for more insights.
Chiropractors may be able to report 99202 under some commercial insurance, Medicaid, workers’ compensation, auto insurance, or other payer arrangements. There is no single rule that applies across every state and plan.
For example, Kentucky’s 2026 Medicaid chiropractor fee schedule includes 99202, while North Carolina’s workers’ compensation chiropractic fee schedule also recognizes the code. These examples show that 99202 can be available to chiropractors outside Original Medicare, although they do not create nationwide billing permission. Auto and no-fault programs may apply their own profession-specific fee schedules and reporting rules.
Before reporting the code, confirm:
The safest approach is to verify the code directly with the payer rather than relying on how another chiropractor or another insurance plan handles it.
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Original Medicare applies much narrower chiropractic coverage rules. CMS limits covered chiropractic services to manual manipulation of the spine to correct a subluxation. Doctors of chiropractic are limited to billing the following three treatment codes under Medicare:
As a result, 99202 billing code should not be presented as a routinely reimbursable Original Medicare service when reported by a chiropractor. CMS also requires the AT modifier for covered active or corrective chiropractic treatment and does not cover maintenance therapy.
See the official CMS Medicare coverage guidance for chiropractic services and its newer chiropractic documentation checklist.
Payer check: A code appearing in the CPT code set does not automatically mean that every payer reimburses it for every practitioner type. Coverage, credentialing, scope, and documentation rules still apply.
Massage therapists should not assume they can report 99202 simply because they complete an intake assessment or evaluate a new client. The visit description alone does not establish eligibility to bill an E/M code.
For Original Medicare, massage therapists are not recognized as qualified therapy professionals who can independently bill services under the outpatient therapy benefit.
However, rules outside Medicare may differ. Some commercial, workers’ compensation, auto, and other plans may reimburse certain massage-related services, while others may require the service to be ordered, supervised, or billed under another eligible practitioner type. Before using 99202 or placing it on a superbill, verify:
A superbill does not bypass these rules. It gives the client documentation to submit, while reimbursement still depends on the plan’s coverage and practitioner eligibility requirements.
Acupuncturists, physical therapists, occupational therapists, counselors, and other practitioners follow profession-specific billing rules. Their ability to use 99202 may depend on state scope, payer recognition, enrollment status, and whether another code family is required for the service.
CMS provides the broader rule: reimbursement for an E/M service requires the practitioner’s state to permit that service within their professional scope. The code must also reflect the patient type, service setting, and level of work performed. See the CMS E/M billing guidance.
For billing purposes, a new patient is not always someone visiting the clinic for the first time.
Under CMS guidance, a patient is generally considered new when they have not received a professional service from:
during the previous three years.
This means a patient may be new to a particular location, staff member, or booking system and still count as established for billing. The practice should review previous encounters across the entire group before selecting 99202.
A practitioner who changes locations should also check whether they have previously treated the patient. Under the CMS definition, seeing the same practitioner within the previous three years generally makes the patient established, even when the visit takes place at a different practice location.
Important: Commercial insurers, Medicaid programs, workers’ compensation plans, and auto insurers may apply their own definitions. Confirm the payer’s policy rather than assuming the CMS rule applies unchanged.
| Scenario | Likely Billing Status | Reasons Why |
|---|---|---|
| A patient has never received services from the chiropractor or another chiropractor in the same group | New | There is no previous professional service within the group |
| A patient saw the same chiropractor 18 months ago at another location | Established | A change of location does not reset the three-year period |
| A patient saw another chiropractor in the same group two years ago | Established | The previous service was provided by the same specialty in the same group |
| A patient last received services from the chiropractor more than three years ago | May qualify as new | The previous service falls outside the three-year period |
| A patient visits a newly opened branch of the same chiropractic group | May qualify as new for the chiropractor | The practitioner type and specialty differ, although payer rules must still be checked |
| A patient saw a practitioner from a different specialty within the same group | May qualify as new | CMS applies the rule to practitioners of the same specialty or subspecialty |
| A patient completed an intake form and booked an appointment but never received a professional service | Generally new | Administrative contact alone does not usually establish a prior professional encounter |
| A patient followed their chiropractor from another practice within the last three years | Established | The patient previously received services from the same practitioner |
These examples are practical starting points rather than universal payment decisions. Before submitting 99202, check the patient’s history by practitioner, specialty, group, and date of service. The practice should also verify the payer’s definition of a new patient, particularly when multiple locations or practitioner types are involved.
New-patient check: “First visit here” and “new patient for billing” can mean two different things. Review the previous three years of professional services before choosing 99202.
A new-patient visit may qualify for 99202 in one of two ways:
This option may apply when the practitioner evaluates a relatively simple concern that requires limited review and carries minimal risk.
Suppose a new patient comes with a single uncomplicated complaint. The chiropractor reviews the relevant history, performs an appropriate evaluation, and recommends a straightforward care plan. The note should clearly show what was assessed and how the practitioner reached the decision.
The visit may also qualify when the practitioner spends 15-29 minutes on the encounter during the same date.
Qualifying time may include:
Only the reporting practitioner’s qualifying time should be counted. Front-desk work, waiting time, and separately billed services are excluded. When selecting 99202 by time, record the total time in the note.
The main differences between these codes are the patient’s status, the level of decision-making, and the total time spent on the visit.
| Billing Code | Patient Status | Decision-Making level | Total Time |
|---|---|---|---|
| 99202 | New | Straightforward | 15-29 minutes |
| 99203 | New | Low | 30-44 minutes |
| 99212 | Established | Straightforward | 10-19 minutes |
| 99213 | Established | Low | 20-29 minutes |
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For a new patient, the 99203 CPT code may be more appropriate when the visit involves low-level decision-making or at least 30 minutes of qualifying time. Codes 99212 and 99213 apply to established patients, so they should not be used simply because the visit is shorter.
The main idea is that the code should reflect the work documented during the encounter.
CMS identifies incorrect coding and insufficient or missing documentation as major causes of E/M claim errors. Common reasons for a 99202 denial include:
Before correcting or appealing a claim, review the denial reason, compare the submitted codes with the encounter note, and confirm the payer’s policy.
Accurate billing is easier when all the connected systems, including the appointment, patient information, documentation, and billing details, stay in the same workflow.
Ruana helps chiropractors, massage therapists, and wellness practices:
This makes it easier to confirm that the codes on an invoice or superbill match the services documented during the visit. Ruana does not currently submit insurance claims through an EDI connection or clearinghouse, so practices should continue to verify payer rules and submit claims through their usual billing process.
Always check the requirements before checkout to reduce avoidable denials and create a clearer billing experience for both the practice and the patient.
Keep your documentation and billing workflow organized with Ruana.
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