In our guide to CPT Code 99203, we’ll teach you about this straightforward complexity evaluation and management procedure code, 99203 guidelines for billing, and the CPT Code 92203 reimbursement rate for Medicare in 2022.
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CPT Code 99203 Definition
99203 Description: Office or other outpatient visit for the evaluation and management of a new patient which requires a medically appropriate history and/or examination and low medical decision making.
CPT Code 99203 Reimbursement Rate (Medicare, 2022): $124.39
In the past years, this E/m code has been paid $113.75 by Medicare in 2021.
CPT Code 99203 Time Length: 30 – 44 Minutes
An average session length for an initial 99203 evaluation and management session is around 35 minutes.
99203 Billing Guidelines:
Using CPT code 99203 requires a medical decision making level of low with a medically appropriate history or examination.
|CPT Code||Medical Decision Making||Time Length||Reimbursement Rate (2022)||Reimbursement Rate (2023)|
|99202||Straightforward||15 - 29 Minutes||$80.91||$72.86|
|99203||Low||30 - 44 Minutes||$124.39||$112.84|
|99204||Moderate||45 - 59 Minutes||$185.26||$167.40|
|99204||High||60 - 74 Minutes||$244.99||$220.95|
“In 2021, new patient codes 99202-99205 no longer require the three key components or reference typical face-to-face time. Instead, each service includes “a medically appropriate history and/or examination,” and code selection is based on the MDM [medical decision making] level or total time spent on that date.”
This decision was made on 1/1/2021 to update the descriptor for Group 1 CPT and HCPCS codes 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215.
Pick the code that is based on the length of service and complexity of medical decision making and appropriate level of care required.
- Medical decision making: low
- Time length: 30 – 44 minutes
- Evaluation of clinical history and examinations
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