CPT code 99203 is the code for a mid-level office or other outpatient visit with a new patient. It is one of the most common new-patient codes, and one of the easiest to get wrong, because the rules for choosing it changed in 2021. If your billing still follows the older “history, exam and decision-making” model, claims can be coded at the wrong level. This guide explains what 99203 covers, how to choose it, and how to bill it cleanly.
What is CPT code 99203?
CPT code 99203 is an evaluation and management (E/M) code from the AMA’s Current Procedural Terminology set. It describes an office or other outpatient visit for a new patient that has either:
- Low-level medical decision-making (MDM), or
- 30 to 44 minutes of total time spent by the physician or other qualified health care professional on the date of the encounter.
You can code the visit by either method. Use whichever one the documentation supports best.
Who counts as a new patient?
A patient is new if they have not received any professional services from you, or from another physician of the exact same specialty and subspecialty in your group practice, within the past three years. If they have, use an established-patient code instead, such as those in our guides to CPT 99213 and CPT 99214.
How to choose 99203: MDM or time
Coding by medical decision-making
MDM has three elements: the problems addressed, the data reviewed and analyzed, and the risk of the patient’s management. To reach a level, meet or exceed two of the three. For low-level MDM (99203), that typically looks like this:
- Problems: two or more self-limited or minor problems, one stable chronic illness, or one acute, uncomplicated illness or injury.
- Data: limited, for example reviewing a small number of tests or documents, or using an independent historian.
- Risk: low risk of morbidity from the patient’s management.
Coding by total time
If you code by time, count the total time the physician or qualified professional spends on the date of the encounter, not just the face-to-face part. That can include reviewing records, taking the history, examining the patient, counseling, ordering tests, documenting and coordinating care. It does not include time spent by clinical staff, or time spent on a separately reported service. For 99203, the range is 30 to 44 minutes.
Documentation is still required
Since 2021, the history and exam no longer decide the level. They only need to be medically appropriate. But the note still has to support the level you bill: the problems addressed, the data reviewed, the risk of the plan, or the total time and what it was spent on. A note that says only “30 minutes” with no detail is easy for a payer to challenge.
99203 compared with the other new-patient codes
| Code | MDM level | Total time on the date of the encounter |
|---|---|---|
| 99202 | Straightforward | 15 to 29 minutes |
| 99203 | Low | 30 to 44 minutes |
| 99204 | Moderate | 45 to 59 minutes |
| 99205 | High | 60 to 74 minutes |
The old code 99201 was deleted in 2021, so you should no longer see it in current guidance. If you do, the source is out of date. Where a visit falls between two levels, code by the method that clearly supports the higher level, and only if the note proves it.
Reimbursement for 99203
Medicare pays for 99203 under the Physician Fee Schedule. The amount changes every year and varies by locality and by whether the visit takes place in a facility or a non-facility setting, such as a private office. Other payers use their own fee schedules. To see the current Medicare rate for your area, use the CMS Physician Fee Schedule tools rather than a rate quoted in an article, because the number goes out of date quickly.
Common mistakes with 99203
- Using the old rules. Coding by “detailed history” and “moderate exam” instead of MDM or time leads to under- and over-coding.
- Counting the wrong time. Only the physician’s or qualified professional’s time on the date of the visit counts. Staff time and time on other days do not.
- Weak documentation. If the note does not show the problems, data and risk, or the time and what it was spent on, the level will not hold up in an audit.
- Billing a new patient code for an established patient. Check the three-year rule before you pick the code.
- Missing a modifier. If a separate procedure is done at the same visit, you may need modifier 25 on the E/M code. Check payer rules.
- Using the code for the wrong visit type. 99203 is for a problem-oriented new-patient visit. A preventive visit uses a preventive medicine code instead.
Billing 99203 by telehealth
Many payers accept 99203 for a new-patient visit by telehealth, with the right modifier and place-of-service code. Rules differ by payer and change often, so check each one first. Our guide to telehealth medical billing covers modifiers, place of service and documentation in more detail.
Frequently asked questions
What does CPT code 99203 mean?
It is an office or other outpatient visit for a new patient with low-level medical decision-making, or 30 to 44 minutes of total physician time on the date of the encounter.
Can I bill 99203 for an established patient?
No. If the patient has been seen by you, or by a physician of the same specialty in your group, within the past three years, use an established-patient code such as 99212 to 99215.
What is the difference between 99203 and 99204?
99204 needs moderate-level MDM or 45 to 59 minutes of total time. 99203 needs low-level MDM or 30 to 44 minutes.
Does clinical staff time count toward the 99203 time range?
No. Only the time of the physician or other qualified health care professional counts.
How do I avoid denials for 99203?
Choose the level by MDM or time, document what supports it, confirm the patient is new, and check the payer’s rules for modifiers and telehealth. For more on common coding errors, see our guide to CPT coding errors.
Conclusion
CPT 99203 is a core new-patient code, and choosing it correctly comes down to three things: confirm the patient is new, pick MDM or time, and write a note that proves the level. Getting this right protects your revenue and keeps your audit risk low.
Billing Care Assistant’s team handles medical billing and coding for practices of every size. Contact us to review your E/M coding.
