# CPT 99205

> Medicare paid $211.12 for CPT 99205 in the office (non-facility) setting and $172.51 in a facility under the Q1 2020 Physician Fee Schedule, effective January 2020. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This is a 0.7% increase from the previous quarter.

## What it is

A high-complexity visit for a new patient — for example, an initial evaluation of multiple poorly controlled chronic conditions or a new problem that could threaten life or bodily function. Total visit time typically runs about 60 to 74 minutes, with documentation supporting an extensive evaluation and high-risk decision-making. It is the highest-level new-patient office visit.

## Selected release

- Release: Q1 2020 (2020 A)
- Effective: January 1 – March 31, 2020
- Status indicator: A
- Office (non-facility) national allowed amount: $211.12
- Facility national allowed amount: $172.51
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.17
- Office (non-facility) practice expense RVU: 2.40
- Facility practice expense RVU: 1.33
- Malpractice RVU: 0.28
- Conversion factor: 36.0896
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q1 2020)
- CMS file: https://www.cms.gov/files/zip/rvu20a-updated-01312020.zip
- Parsed file: PPRRVU20_Jan.csv, row 17,059
- Canonical page: https://localishealth.com/cpt/99205/2020/A
- Release-specific citation URL: https://localishealth.com/cpt/99205/2020/A
- Last significant update: 2026-08-04T03:09:22+00:00