CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Inpatient hospital care
99202 — Office/outpatient visit, new patient; straightforward MDM
This code covers a new patient office visit — someone who has not been seen by a provider in the practice within the past three years — when the medical issue is straightforward, such as a minor acute illness with an ...
- Typical setting: Hospital inpatient or observation
- National avg charge (illustrative): $65-$120 Medicare allowed (approx. $70-$90 national Medicare average; commercial payers $90-$160)
- Most-disputed reason: Billing deleted code 99201 on or after January 1, 2021 — this code no longer exists and will be denied
What it means
What 99202 actually means
This code covers a new patient office visit — someone who has not been seen by a provider in the practice within the past three years — when the medical issue is straightforward, such as a minor acute illness with an established treatment plan. Note: CPT 99201 was deleted effective January 1, 2021; 99202 is now the lowest-level new patient outpatient office code.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing deleted code 99201 on or after January 1, 2021 — this code no longer exists and will be denied
- New vs. established patient error: billing 99202 for a patient who is established (seen within 3 years), which should use 99212 instead
- Upcoding: selecting 99204 or 99205 for a minor acute visit without documentation of moderate or high MDM
If you see 99202 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 99202 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 99202 on a bill.
99202 FAQ
Plain-English answers.
What does 99202 usually cost?
$65-$120 Medicare allowed (approx. $70-$90 national Medicare average; commercial payers $90-$160). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 99202?
Billing deleted code 99201 on or after January 1, 2021 — this code no longer exists and will be denied
What should I do if I see 99202 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 99202 before paying.
Don't pay 99202 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.