You’ll receive a document with a CPT code when you visit the doctor for the first time. The code assists doctors, clinics, and insurance companies in being organized and fair.
One of the most common billing codes for a new patient visit is CPT Code 99203.
At Health Med Affairs, one of Texas’s top medical billing companies, we help providers use the correct CPT codes to reduce denials, get paid faster, and improve revenue.
Below, we’ll explain everything you need to know about CPT Code 99203 in a way that’s easy to understand, even if you have no medical background.
What Does CPT Code 99203 Mean?
CPT Code 99203 is for a new patient visit. It includes low to medium complexity in healthcare choices (MDM) and about 30 minutes of direct dialogue.
It is used when the provider is:
- Taking a detailed history
- Performing a detailed physical examination
- Making low to moderate complexity medical decisions
The CPT guidelines state that the patient must be new. This means they haven’t received professional services from the physician or another doctor of the same specialty in the same group for the last three years. This is why CPT Code 99203 is commonly used in clinics and doctors’ offices.
What Is Included in a 99203 Visit?
When billing procedure code 99203, providers should ensure the visit includes:
- A detailed review of medical, family, and social history
- A comprehensive physical exam
- Clinical documentation of presenting problems
- Development of a care plan or further testing
- 30 minutes spent face-to-face with the patient
Our coders at Health Med Affairs ensure your documentation fully supports the code billed, helping you meet audit standards and improve clean claim rates.
How Long Does a 99203 CPT Code Visit Take?
The typical visit time for CPT Code 99203 is 30 minutes. This includes:
- Evaluation
- Counseling
- Coordination of care
If you are coding based on time rather than MDM, document the total time and services provided.
At Health Med Affairs, we help you understand when time-based coding is appropriate and how to document it correctly.
What Is the 99203 CPT Code Cost?
The cost of CPT Code 99203 reimbursement varies depending on:
- Your geographic location
- The type of payer (like Medicare, Medicaid, or commercial)
- If your provider is in-network
The average reimbursement goes between 100 and 200 on CPT 99203; however, it may vary depending on the payer’s fee schedule.
Payer-specific rate searches or a billing company, such as Health Med Affairs, are used to obtain an optimal reimbursement.
Our Health Med Affairs team can advise you on maximizing reimbursements and provide prior authorizations when requested.
Who Uses CPT Code for Office Visits?
Healthcare professionals use CPT code 99203 like:
- Family doctors
- Internal medicine doctors
- Nurse practitioners
- Physician assistants
They use this code only for new patients. That means it’s your first time seeing that provider, or over three years since your last visit.
The provider will allocate another code if you are already under treatment and visiting again. One is the 99213 medical billing code applicable in cases with established patients and low levels of need.
Adequate differentiation of new and established patients will limit coding errors, lower rejection rates, and guarantee the proper reimbursement by the payers.
Our team at Health Med Affairs ensures that the patient’s accurate status is recorded, which helps eliminate one of the most common billing errors, coding new visits as established or vice versa.
Common Reasons for 99203 Claim Denials
At Health Med Affairs, we see common denial trends for CPT Code 99203:
- Insufficient documentation to support low-level MDM
- Used for established patients instead of new ones
- Missing modifiers for telehealth services
- Overcoding or undercoding based on actual service time or complexity
At Health Med Affairs, we provide denial management and compliance reviews to help prevent revenue leaks.
How Is CPT Code 99203 Different from Other Visit Codes?
The CPT codes depend on the amount of time that should be spent with a patient and the complexity of the doctor’s decision. Some of the codes are short visits, and others are long appointments, which are more involved.
For instance:
- 99202 is applicable when a quick visit lasts about 20 minutes and has a simple medical issue.
- 99204 covers more serious issues that need a minimum of 45 minutes of the provider’s attention.
CPT Code 99203 falls between basic and complex visit codes, making it suitable for moderate patient evaluations.
Why Accurate Coding for 99203 Matters
Accurate use of 99203 has a direct impact on:
- Revenue Integrity: Prevents underbilling or overbilling
- Compliance: Supports clean claims and audit defense
- Provider Efficiency: Reduces administrative burden
- Patient Trust: Clear and consistent billing improves patient-provider relationships
Billing partner services with experts guarantee that your coding indicates the full worth of provided care.
How to Improve CPT Code 99203 Accuracy in Your Practice
Documentation and coding accuracy speed up payment and prevent denials. Audits and training ensure it.
At Health Med Affairs, we suggest scheduling periodic reviews of your EHR (Electronic Health Record) templates. This ensures all necessary components of a 99203 visit are captured clearly and consistently.
Medical decision-making (MDM) is vital for selecting this code correctly. Providers must assess if the patient’s problems, data reviewed, and risk levels match low to moderate complexity.
Overcoding can lead to payer audits, and undercoding results in lost revenue. This is why we stress documentation integrity; even one missing element can change the code.
Practices should also stay updated with annual CPT code changes. Guidelines can shift over time. Knowing the latest updates helps your billing team remain compliant and avoid outdated coding practices that could risk your claims.
By partnering with Health Med Affairs, you can access certified coders, personalized guidance, and a dedicated revenue cycle team. We focus on maximizing reimbursement and minimizing risk. From new patient visits to complex billing issues, we simplify the process so you can concentrate on patient care.
Final Thoughts on CPT Code 99203
CPT Code 99203 is key for billing. It indicates that a doctor spent enough time with a new patient and made low to moderate decisions. This code includes reviewing health history and planning next steps.
Using this code helps ensure fair payment for healthcare providers. It also supports clear communication and proper documentation for patient care.
It prepares billing teams for audits and guarantees fair service compensation when applied correctly.
Whether you run a small clinic or a large group, partnering with a professional billing team like Health Med Affairs can simplify your workflows. This partnership also aids in achieving long-term financial stability.
Need Help with CPT Coding or Denial Management?
Health Med Affairs offers full-service medical billing and coding support tailored to your practice’s needs.
From CPT code optimization to denial management and AR recovery, we help Texas providers grow revenue while staying compliant—partner with experts who know the codes inside and out.
Contact us today to get started with expert support you can trust.
FAQs
Q: Can 99203 be used for follow-up visits?
No. This code is only for new patients or those not seen in over 3 years.
Q: Is 99203 valid for virtual visits?
Yes, Modifier 95. Confirm with payer-specific telehealth guidelines always.
Q: What causes denials of CPT 99203?
Common reasons include a lack of documentation, using the wrong patient status, or incorrect coding for visit complexity.
Q: What should be included in the documentation?
Record time (if time-based), history, exam, and clear evidence of low to moderate MDM.
