CPT Code 99203: Billing Guide & Reimbursem*nt Rates [2024] (2024)

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 reimbursem*nt rate for Medicare in 2024.

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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.

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CPT Code 99203 Reimbursem*nt Rate (Medicare, 2024): $109.69

In the past years, this E/m code has been paid $113.75 by Medicare in 2021.
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CPT Code 99203 Time Length: 30 – 44 Minutes

An average session length for an initial 99203 evaluation and management session is around 35 minutes.

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99203 Billing Guidelines:

Using CPT code 99203 requires a medical decision making level of low with a medically appropriate history or examination.

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“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.”

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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.

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Pick the code that is based on the length of service and complexity of medical decision making and appropriate level of care required.

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99203 Requirements:

• Medical decision making: low
• Time length: 30 – 44 minutes
• Evaluation of clinical history and examinations

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