Established Patient vs. New Patient: Definition, Benefits, and Registration

Definitions (CMS / CPT)

• New Patient: No professional service from same specialty/subspecialty in same group within past 3 years.
• Established Patient: Received professional service from same specialty/subspecialty in same group within 3 years.

Benefits of Being Established

• Continuity: Provider knows history, preferences, social context.
• Efficiency: Less intake paperwork; focused visits.
• Access: Same-day/next-day slots often reserved for established patients.
• Portal Access: Messaging, refills, results, scheduling.
• Care Coordination: Seamless referrals, integrated records.
• Cost: Established E/M codes (99211–99215) reimburse less than new (99201–99205) — but patient copay often similar.

Becoming Established

1. Complete new patient registration (demographics, insurance, HIPAA, consent).
2. Provide prior records (releases signed).
3. Attend first visit (comprehensive history, exam, plan).
4. Subsequent visits = established.

Special Cases

• Different provider, same group/specialty → established.
• Different specialty → new patient for that specialty.
• >3 years gap → new patient again.