The 99203 CPT code reports a new patient office or outpatient visit with low medical decision making (MDM) or at least 30 minutes of total practitioner time on the date of service. It is level 3 of the four new patient codes, 99202 through 99205.
Many practices either undercode these visits as 99202 or overcode them as 99204. Both mistakes cost money, either in lost revenue or audit risk. This guide explains exactly when 99203 applies, how to document it, and how to avoid common billing errors.
99203 at a glance
Two ways to support a 99203 visit
Low MDM
Meet 2 of 3 elements: low problems, limited data, and low risk.
Time
You need at least 30 minutes of total practitioner time on the date of the visit.
New patient
No professional services from you or a same-specialty colleague in your group in the past 3 years.
Choose MDM or time, whichever better supports the visit.
What Is the 99203 CPT Code?
Since the 2021 E/M changes, office visit levels are chosen by MDM or total time. History and exam must be medically appropriate, but they no longer set the level. Therefore, a 99203 note should focus on decision making or clearly documented time.
| Code | MDM level | Total time (meet or exceed) |
|---|---|---|
| 99202 | Straightforward | 15 minutes |
| 99203 | Low | 30 minutes |
| 99204 | Moderate | 45 minutes |
| 99205 | High | 60 minutes |
Who Counts as a New Patient for 99203?
A new patient has not received professional services from the physician or QHP, or from another physician or QHP of the exact same specialty and subspecialty in the same group, within the past three years. In contrast, a patient seen by a different specialty in your group can still be new to you.
Low MDM Requirements for the 99203 CPT Code
To meet low MDM, the visit must satisfy two of the three elements below.
| Element | Examples that meet the low level |
|---|---|
| Number and complexity of problems | Two or more self-limited or minor problems; one stable chronic illness; one acute, uncomplicated illness or injury |
| Data reviewed and analyzed | Two items such as reviewing external notes, reviewing a unique test result, or ordering a unique test; or an independent historian |
| Risk of patient management | Low risk, such as over-the-counter drug management or minor tests |
Note that prescription drug management usually counts as moderate risk. As a result, a new patient visit with prescription management and a moderate problem often supports 99204 instead. For established patient visits, see our 99213 guide for established patients.
Time-Based Coding for the 99203 CPT Code
Alternatively, you can select 99203 when total practitioner time on the date of the encounter is at least 30 minutes. Time includes preparing to see the patient, history, exam, counseling, ordering tests, documenting, and coordinating care. However, it excludes separately reported services and clinical staff time.
In addition, document the total minutes and the main activities. For example: “Total time on the date of service: 34 minutes, including record review, exam, counseling on treatment options, and documentation.”
99203 CPT Code Documentation Examples
Supports 99203 by MDM: “New patient with acute uncomplicated low back strain. Reviewed outside urgent care note and prior X-ray report. Recommended OTC NSAIDs, heat, and home exercises. Return if symptoms persist.” In this case, one acute uncomplicated problem, limited data, and low risk meet low MDM.
Too thin to support 99203: “New patient, minor rash, cream recommended.” Here, the note lacks data and detail, so it likely supports 99202 only.
99203 Billing Guidelines and Reimbursement
- Use POS 11 for the office; outpatient hospital settings use POS 22 or 19 as appropriate
- Add modifier 25 only for a significant, separately identifiable E/M on the same day as a procedure
- Use modifier 57 when the visit results in the decision for major surgery
- Link diagnoses that reflect the problems actually addressed
In general, payment varies by payer and location. For Medicare, check your local amount in the CMS Physician Fee Schedule Look-Up Tool. Commercial and Medicaid rates follow each contract or state fee schedule.
Common 99203 CPT Code Errors
- First, undercoding to 99202 when low MDM or 30 minutes is clearly documented
- Second, overcoding to 99204 without moderate MDM or 45 minutes
- Also, recording time without stating the total minutes
- Finally, billing a new patient code for a patient seen by the same specialty in your group within three years
Regular internal audits catch these patterns early. For more on the risks, read our guide to upcoding and downcoding.
How Dr Biller RCM Helps With E/M Coding
Our certified coders review E/M levels, flag documentation gaps, and train providers on MDM and time rules. Through our physician billing services and internal medicine billing, we help practices bill new patient visits accurately and defend them in audits.
Request a free E/M coding audit and see whether your new patient visits are coded correctly.
Frequently Asked Questions
What MDM level does the 99203 CPT code require?
99203 requires low medical decision making. Moderate MDM supports 99204.
How many minutes are required for 99203?
You need at least 30 minutes of total practitioner time on the date of the encounter.
What is the difference between 99202 and 99203?
99202 requires straightforward MDM or 15 minutes, while 99203 requires low MDM or 30 minutes.
Can I bill 99203 with a procedure on the same day?
Yes, if the visit is significant and separately identifiable from the procedure. In that case, append modifier 25 and document the visit separately.
