Understanding the Difference: What is the difference between a physical and a new patient visit?

October 1, 2025 •

4 min read

According to the American Academy of Family Physicians, a new patient visit involves more detailed work for providers due to the comprehensive history and record-building required. Understanding what is the difference between a physical and a new patient visit is crucial for ensuring you receive the correct care and are billed appropriately for your appointment.

Quick Summary

A new patient visit is for establishing care with a provider, including a comprehensive health history and assessment. A physical is an annual preventive check-up focused on overall wellness and screening. They differ in purpose, time, and billing.

Key Points

New vs. Established: The primary distinction depends on your relationship with the practice; you're a "new patient" if you haven't received services from that provider or same-specialty group in the last three years.
Purpose: A new patient visit is for establishing your full medical history with a new doctor, while a physical focuses specifically on preventive care and screenings.
Complexity: New patient visits are often longer and require more extensive information gathering and documentation than routine physicals.
Billing: Insurance coding differs significantly; a new patient visit uses different codes than an established patient's physical, which can impact your out-of-pocket costs.
Overlap: A physical exam can be part of a new patient visit, but the comprehensive history required for a new patient often leads to different billing practices.
Medicare Consideration: An Annual Wellness Visit (AWV) for Medicare is different from a physical and focuses on risk assessment and planning, not a hands-on exam.
Addressing Issues: Raising a new or chronic issue during a physical may result in a separate evaluation and management (E/M) charge in addition to the preventive visit.

For many people, the terms "physical exam" and "new patient visit" can seem interchangeable, but they serve distinct purposes in the world of healthcare. While a physical is a routine, preventive check-up designed to maintain your health, a new patient visit is a comprehensive, foundation-building appointment to establish a relationship with a new healthcare provider. Knowing the specifics of each can help you prepare effectively, manage your healthcare, and understand your billing.

The New Patient Visit: Establishing Your Healthcare Foundation

A new patient visit is your first meeting with a new healthcare provider or practice. It is designed to be a comprehensive, foundational appointment where the provider gathers extensive information about your medical history, family background, and current health status. The primary goal is to build a detailed patient record, not just to address a single problem or perform a preventive exam.

What to Expect During a New Patient Visit

Extensive Paperwork: Expect to arrive early to fill out detailed forms covering your personal health history, family medical history, current medications, allergies, and lifestyle habits.
Thorough Discussion: The provider will spend a significant amount of time talking with you to understand your health concerns, review your past medical treatments, and learn about your overall lifestyle. This conversation is key to establishing a baseline of your health.
Comprehensive Evaluation: The provider will conduct a general physical examination, which may involve checking vital signs, listening to your heart and lungs, and performing other basic checks. However, this exam is part of a larger, holistic evaluation rather than the sole focus.
Developing a Care Plan: Based on the gathered information, the provider will work with you to create a personalized health plan. This may include ordering baseline lab tests, scheduling initial screenings, or coordinating care with other specialists.

Because of the extensive information gathering, a new patient visit is typically longer and more detailed than a follow-up appointment. It establishes the critical provider-patient relationship that will guide your future care.

The Annual Physical Exam: A Focus on Prevention

The annual physical exam, also known as a preventive health exam, is a yearly check-up with your established provider. The focus is on preventing illness and maintaining your overall well-being rather than addressing a new, specific health problem.

What to Expect During an Annual Physical

Vital Signs and Measurements: The appointment usually begins with a medical assistant checking your vital signs, such as blood pressure, heart rate, and weight.
Preventive Screenings: The provider will perform a hands-on physical check and may order age-appropriate screenings. These can include:
- Blood tests (e.g., cholesterol, blood sugar)
- Cancer screenings (e.g., mammogram, Pap smear, prostate exam)
- Immunizations (e.g., flu shot)
- Vision and hearing tests
Review of Wellness Plan: The doctor will discuss your overall health, lifestyle choices (diet, exercise), and any recent changes in your health. This is a time to reinforce healthy habits and catch potential issues early.

It is important to note that if you bring up a new or existing health problem that requires significant evaluation or treatment during a physical, the provider may need to bill for a separate office visit, in addition to the preventive service. This is a common point of confusion regarding insurance coverage.

Key Differences and Overlap

To help clarify the differences between these two types of visits, here is a comparison table:


Feature	New Patient Visit	Annual Physical Exam
Purpose	To establish care with a new provider and build a complete health record.	To prevent illness and screen for health problems in an existing patient.
Patient Status	Defined by CPT as someone not seen by the provider or group within the last 3 years.	An established patient who has been seen by the provider or group within the last 3 years.
Scope	Broad and comprehensive, gathering all-encompassing health data.	Focused on age-appropriate preventive screenings and overall wellness.
Typical Duration	Often longer than a standard visit due to paperwork and in-depth history taking.	Standard appointment length, focused on the preventive exam and screening.
Billing/Coding	Uses specific "new patient" codes (e.g., 99202–99205) reflecting the complexity of the initial work.	Billed with specific preventive medicine codes (e.g., 99381–99397).
Issue Management	Can address new or existing health problems in detail during the visit.	Addressing significant issues during a physical can lead to a separate, additional charge.

Can a New Patient Visit Also Be a Physical?

Yes, in many cases, a new patient visit will include the components of a physical exam. For example, if you are establishing care with a new primary care physician, they will perform a physical exam and conduct preventive screenings as part of that initial comprehensive evaluation. The key distinction is the billing. Your provider may still bill for the higher-level new patient code because of the additional work involved in building your chart and history. It is always best to clarify with the office what type of visit is being scheduled and how it will be coded, especially regarding potential co-pays or coverage based on your insurance plan.

Conclusion: Choosing the Right Appointment

Understanding the distinction between a new patient visit and a physical is fundamental for navigating your healthcare effectively. A new patient visit is a crucial first step to create a long-term healthcare partnership with a new provider, focusing on gathering comprehensive history. A physical, on the other hand, is a yearly maintenance check-up for established patients, centered on proactive health prevention. By knowing the purpose and expectations of each, you can ensure you receive the right type of care at the right time. For more information on E/M coding for these visits, you can refer to resources from organizations like the American Academy of Family Physicians.

Frequently Asked Questions

Your first visit is longer because it is a new patient visit, which requires your provider to gather a complete medical history, review records, and establish your health baseline, in addition to performing any necessary exams.

Yes, but be aware that if you discuss a new or existing health problem that requires significant evaluation during your physical, your provider may need to bill for both a preventive and an evaluation and management (E/M) service, which could affect your insurance coverage and costs.

A new patient visit often includes a physical exam as part of the overall comprehensive health assessment, but the primary purpose is to establish care and gather your full medical history, which is why the visit is coded differently.

The three-year rule is used for billing purposes; if you have not received professional services from a physician or group practice of the same specialty within the past three years, you are considered a new patient.

No, a Medicare Annual Wellness Visit is different. It is a 'hands-off' visit focused on creating a personalized prevention plan and assessing health risks, whereas a physical includes a hands-on examination.

Bring a photo ID, insurance card, a list of your current medications (including supplements), and details about your medical and family health history to help your provider establish your records.

Billing is different because the CPT codes used reflect the level of work and complexity of the visit. A new patient visit requires more administrative and evaluation work from the provider than a routine physical for an established patient.