CPT Code 99205: Office visit, new patient, high complexity

When to Use CPT 99205

Use CPT code 99205 when billing for office visit, new patient, high complexity. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.

Adding CPT 99205 to a Superbill

When generating a superbill with CPT 99205, include the ICD-10 diagnosis code, date of service, fee charged, amount paid, and your NPI number. Superbilled pre-fills common therapy CPT codes automatically.

Common ICD-10 Pairings

These diagnosis codes are frequently used alongside CPT 99205:

Documentation Requirements

Document high-complexity medical decision making with extensive data review and high-risk management. Include comprehensive history, exam, and treatment plan.

Common Denial Reasons

• ✗ Documentation does not support high-complexity decision making
• ✗ Downcoded to 99204 — risk of morbidity not clearly documented
• ✗ Missing comprehensive assessment documentation

Got one of these on a remittance? Decode the denial code.

Reimbursement Expectations

OON reimbursement typically 50-70% of UCR. Expect $100-$245 from commercial plans.