CPT Procedure Codes Subject to the Legislated Visit Limit
Code Description
T1015 Clinic visit/encounter, all inclusive
90865 Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (Amytal)
interview)
92002 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment
program; intermediate, new patient
92004 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment
program; comprehensive, new patient, 1 or more visits
92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic
and treatment program; intermediate, established patient
92014 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic
and treatment program; comprehensive, established patient, 1 or more visits
98940 Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
98941 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions
98942 Chiropractic manipulative treatment (CMT); spinal, 5 regions
99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3
key components: A problem focused history; A problem focused examination; Straightforward medical
decision making. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are
spent face-to-face with the patient and/or family.
99202 Office or other outpatient visit for the evaluation and management of a new patient, which requires a
medically appropriate history and/or examination and straightforward medical decision making. When
using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
99203 Office or other outpatient visit for the evaluation and management of a new patient, which requires a
medically appropriate history and/or examination and low level of medical decision making. When using
time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
99204 Office or other outpatient visit for the evaluation and management of a new patient, which requires a
medically appropriate history and/or examination and moderate level of medical decision making. When
using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
99205 Office or other outpatient visit for the evaluation and management of a new patient, which requires a
medically appropriate history and/or examination and high level of medical decision making. When using
time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
99211 Office or other outpatient visit for the evaluation and management of an established patient that may not
require the presence of a physician or other qualified health care professional
99212 Office or other outpatient visit for the evaluation and management of an established patient, which
requires a medically appropriate history and/or examination and straightforward medical decision making.
When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
99213 Office or other outpatient visit for the evaluation and management of an established patient, which
requires a medically appropriate history and/or examination and low level of medical decision making.
When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
99214 Office or other outpatient visit for the evaluation and management of an established patient, which
requires a medically appropriate history and/or examination and moderate level of medical decision
making. When using time for code selection, 30-39 minutes of total time is spent on the date of the
encounter.
99215 Office or other outpatient visit for the evaluation and management of an established patient, which
requires a medically appropriate history and/or examination and high level of medical decision making.
When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.
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Code Description
99241 Office consultation for a new or established patient, which requires these 3 key components: A problem
focused history; A problem focused examination; and Straightforward medical decision making. Counseling
and/or coordination of care with other physicians, other qualified health care professionals, or agencies are
provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the
presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient
and/or family.
99242 Office consultation for a new or established patient, which requires these 3 key components: An expanded
problem focused history; An expanded problem focused examination; and Straightforward medical decision
making. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are
spent face-to-face with the patient and/or family.
99243 Office consultation for a new or established patient, which requires these 3 key components: A detailed
history; A detailed examination; and Medical decision making of low complexity. Counseling and/or
coordination of care with other physicians, other qualified health care professionals, or agencies are
provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the
presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the
patient and/or family.
99244 Office consultation for a new or established patient, which requires these 3 key components: A
comprehensive history; A comprehensive examination; and Medical decision making of moderate
complexity. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60
minutes are spent face-to-face with the patient and/or family.
99245 Office consultation for a new or established patient, which requires these 3 key components: A
comprehensive history; A comprehensive examination; and Medical decision making of high complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or
agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.
Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-
face with the patient and/or family.
99324 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3
key components: A problem focused history; A problem focused examination; and Straightforward medical
decision making. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are
spent with the patient and/or family or caregiver.
99325 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3
key components: An expanded problem focused history; An expanded problem focused examination; and
Medical decision making of low complexity. Counseling and/or coordination of care with other physicians,
other qualified health care professionals, or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate
severity. Typically, 30 minutes are spent with the patient and/or family or caregiver.
99326 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3
key components: A detailed history; A detailed examination; and Medical decision making of moderate
complexity. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45
minutes are spent with the patient and/or family or caregiver.
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Code Description
99327 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3
key components: A comprehensive history; A comprehensive examination; and Medical decision making of
moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health
care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are
spent with the patient and/or family or caregiver.
99328 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3
key components: A comprehensive history; A comprehensive examination; and Medical decision making of
high complexity. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring
immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver.
99334 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires
at least 2 of these 3 key components: A problem focused interval history; A problem focused examination;
Straightforward medical decision making. Counseling and/or coordination of care with other physicians,
other qualified health care professionals, or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or
minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.
99335 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires
at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem
focused examination; Medical decision making of low complexity. Counseling and/or coordination of care
with other physicians, other qualified health care professionals, or agencies are provided consistent with
the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are
of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver.
99336 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires
at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision
making of moderate complexity. Counseling and/or coordination of care with other physicians, other
qualified health care professionals, or agencies are provided consistent with the nature of the problem(s)
and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity.
Typically, 40 minutes are spent with the patient and/or family or caregiver.
99337 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires
at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination;
Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other
physicians, other qualified health care professionals, or agencies are provided consistent with the nature of
the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate
to high severity. The patient may be unstable or may have developed a significant new problem requiring
immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver.
99341 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A
problem focused history; A problem focused examination; and Straightforward medical decision making.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or
agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.
Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the
patient and/or family.
99342 Home visit for the evaluation and management of a new patient, which requires these 3 key components:
An expanded problem focused history; An expanded problem focused examination; and Medical decision
making of low complexity. Counseling and/or coordination of care with other physicians, other qualified
health care professionals, or agencies are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30
minutes are spent face-to-face with the patient and/or family.
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Code Description
99343 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A
detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling
and/or coordination of care with other physicians, other qualified health care professionals, or agencies are
provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the
presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with
the patient and/or family.
99344 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A
comprehensive history; A comprehensive examination; and Medical decision making of moderate
complexity. Counseling and/or coordination of care with other physicians, other qualified health care
professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are
spent face-to-face with the patient and/or family.
99345 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A
comprehensive history; A comprehensive examination; and Medical decision making of high complexity.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or
agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.
Usually, the patient is unstable or has developed a significant new problem requiring immediate physician
attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
99347 Home visit for the evaluation and management of an established patient, which requires at least 2 of these
3 key components: A problem focused interval history; A problem focused examination; Straightforward
medical decision making. Counseling and/or coordination of care with other physicians, other qualified
health care professionals, or agencies are provided consistent with the nature of the problem(s) and the
patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15
minutes are spent face-to-face with the patient and/or family.
99348 Home visit for the evaluation and management of an established patient, which requires at least 2 of these
3 key components: An expanded problem focused interval history; An expanded problem focused
examination; Medical decision making of low complexity. Counseling and/or coordination of care with other
physicians, other qualified health care professionals, or agencies are provided consistent with the nature of
the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to
moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349 Home visit for the evaluation and management of an established patient, which requires at least 2 of these
3 key components: A detailed interval history; A detailed examination; Medical decision making of
moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health
care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's
and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40
minutes are spent face-to-face with the patient and/or family.
99350 Home visit for the evaluation and management of an established patient, which requires at least 2 of these
3 key components: A comprehensive interval history; A comprehensive examination; Medical decision
making of moderate to high complexity. Counseling and/or coordination of care with other physicians,
other qualified health care professionals, or agencies are provided consistent with the nature of the
problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to
high severity. The patient may be unstable or may have developed a significant new problem requiring
immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.
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