CPT 99205 code and billing history
Material coding, documentation, and Medicare billing changes, shown by effective date and backed by the source that established each change.
Investigated Jan 1, 2013–Aug 3, 2026
1 evidence limitationThe scoped review found the 2021 office/outpatient E/M overhaul and the 2021, 2024, and 2025 G2211 billing transitions. No other material code-specific semantic or Medicare base/add-on transition was located from 2013 through the review date.
Review scope and evidence limits
Scope: Material code-definition, visit-level selection, time and medical-decision-making rules, and Medicare base/add-on billing transitions. Routine RVU and payment changes are shown separately in rate history. Broad temporary delivery waivers and editorial descriptor formatting that did not change a reporting boundary are excluded.
Known limitation: A complete date-stamped public set of annual CPT guidance for 2013-2020 was not available from the authoritative web sources reviewed. The pre-2021 continuity conclusion is anchored by CMS's dated 2013 billing guidance and its 2021 description of the prior framework, rather than independently rechecked against every annual CPT edition.
- CMS 2013 PQRS preventive care measures guide — Page 1, Medicare Part B FFS patient-selection instructions.
- CMS CY2021 office/outpatient E/M payment fact sheet — Pages 1-2, office/outpatient framework and G2211 sections.
- AMA office/outpatient E/M time-range guidance — Documenting and coding based on time, CPT code and time range table.
- CMS MLN Matters MM13272: G2211 payment and modifier 25 edits — Pages 1-2.
- CMS Change Request 13705: G2211 with listed preventive services — Pages 1-3 and Attachment 1.
Changes to 99205 Copy link
Changes to this code’s definition, documentation, selection, or payment status.
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Effective Jan 1, 2021
The 60-74 minute time range took effect
When time is used instead of medical decision making to select 99205, the applicable total-time range is 60-74 minutes on the encounter date.
- After
- 60–74 minutes · total time on encounter date
View evidence (2 sources)
- Primary: AMA office/outpatient E/M time-range guidance — Documenting and coding based on time, CPT code and time range table.
- Corroborating: CMS CY2021 office/outpatient E/M payment fact sheet — Page 1, first four paragraphs and prolonged-visit table.
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Effective Jan 1, 2021
Office-visit level selection changed
Starting in 2021, office/outpatient visit levels 2 through 5 are selected using either medical decision making or total practitioner time on the encounter date. History and examination remain medically appropriate parts of the visit, but no longer determine its level.
- Before
- History, examination, and medical decision making were key components; time described typical face-to-face time.
- After
- Medical decision making or total practitioner time on the encounter date; history and examination as medically appropriate.
Also affects 99202, 99203, 99204, 99212, 99213, 99214, 99215
View evidence (2 sources)
- Primary: CMS CY2021 office/outpatient E/M payment fact sheet — Page 1, first three paragraphs.
- Corroborating: AMA CPT Editorial Panel actions for the 2021 office/outpatient E/M revisions — Agenda item 6, Office or Other Outpatient Services.
Related Medicare add-on policy: G2211 Copy link
Changes to the separate G2211 add-on code that affect when it may be reported and paid with 99205.
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Effective Jan 1, 2025
G2211 gained a limited modifier 25 exception
Medicare began allowing G2211 with a qualifying office/outpatient E/M base code, 99202-99205 or 99211-99215, with modifier 25 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
- Before
- G2211 was denied whenever the associated office/outpatient E/M base visit carried modifier 25.
- After
- A limited exception permits G2211 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
Also affects 99202, 99203, 99204, 99211, 99212, 99213, 99214, 99215, G2211
View evidence (2 sources)
- Primary: CMS Change Request 13705: G2211 with listed preventive services — Pages 1-3 and Attachment 1.
- Corroborating: CMS CY2025 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
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Effective Jan 1, 2024
G2211 became separately payable
Medicare began paying G2211 in addition to qualifying office/outpatient E/M base visits, codes 99202-99205 and 99211-99215. At launch, G2211 was not payable when the base visit carried modifier 25.
- Before
- G2211 was reportable for qualifying visits but bundled, with no separate Medicare payment.
- After
- G2211 was separately payable for qualifying visits unless the associated base visit was reported with modifier 25.
Also affects 99202, 99203, 99204, 99211, 99212, 99213, 99214, 99215, G2211
View evidence (2 sources)
- Primary: CMS MLN Matters MM13272: G2211 payment and modifier 25 edits — Pages 1-2, Action Needed and Background.
- Corroborating: CMS CY2024 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
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Effective Jan 1, 2021
G2211 became reportable, but remained bundled
For qualifying longitudinal-care visits, G2211 could be reported with any new- or established-patient office/outpatient visit level, 99202-99205 or 99211-99215. Medicare assigned it bundled status, so it did not produce separate payment.
- Before
- No G2211 reporting relationship applied to these visits.
- After
- G2211 was reportable for qualifying longitudinal-care visits but bundled under the Medicare Physician Fee Schedule.
Also affects 99202, 99203, 99204, 99211, 99212, 99213, 99214, 99215, G2211
View evidence (2 sources)
- Primary: CMS CY2021 office/outpatient E/M payment fact sheet — Page 2, Add-on Code for Visit Complexity.
- Corroborating: CMS CY2024 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
Looking for payment amounts instead? See the Medicare rate history for 99205.