CPT Code 99203: What You Need To Know in 2024

May 20, 2024

CPT Code 99203: What You Need To Know in 2024

CPT code 99203 is used for new patient or outpatient visits that require a low medical decision-making complexity and/or 30-44 minutes of encounter time. 

This code has a lower reimbursement rate than higher-level codes like CPT code 99204 or CPT code 99205, but it’s important to know when you should code for 99203… 

Otherwise, you might miss out on those higher reimbursement opportunities. 

Let’s check out all the details, including how you can bring your medical coding and billing game up a notch!


Key Points:

  • CPT code 99203 is used for new patient office or outpatient visits that require a low complexity in medical-decision making and/or 30-44 minutes of patient encounter time.
  • Many practices undercode with CPT code 99203 because they don’t know when to use higher-level codes.
  • Understanding when and why to code 99203 is important to get reimbursed properly.

What is CPT Code 99203?

CPT code 99203 is a medical billing code under the Current Procedural Terminology (CPT) system, which is used by healthcare providers to report and bill outpatient and office procedures. 

This specific code is used for new patient visits that involve assessment and management with a low complexity level of medical decision-making (MDM).

You can also code 99203 for time since E/M coding changes in 2021

In this case, you can code it if there was a single encounter time of 30-44 minutes on the visit date.

CPT Code 99203 Description: New patient visits with a low complexity of medical decision-making and 30-44 minutes of encounter time. 

The Importance of 99203 in Patient Care & Billing

Proper use of 99203 CPT code not only ensures fair compensation for the initial patient evaluation, but also establishes a documented medical necessity for potential follow-up care or procedures. 

This makes it easier for other healthcare professional to know what happened at your encounter with the patient.

Plus, it’s important for getting properly reimbursed!

CPT Code 99203 Requirements

To correctly use CPT code 99203, healthcare providers must meet specific criteria:

  • A low level of medical decision-making
  • 30-44 minutes of patient encounter time
  • A comprehensive medical history/patient examination

There were changes made in 2021 to new patient CPT codes (99202-99205) that took weight off of detailed examination criteria, but put more emphasis on MDM and encounter time.

That’s why you can code 99203 based on time or medical decision-making now.

99203 CPT Code Reimbursement Rates in 2024

The Medicare reimbursement rate for CPT code 99203 in 2024 is $111.51.

It’s popularly used when undercoding for things like CPT code 99204 or CPT code 99205, which have a significantly higher reimbursement rate (more on that in a bit).

Common Mistakes to Avoid

Proper billing of CPT code 99203 ensures that your wallet stays healthy.

Try to avoid these common mistakes:

  • Under-documentation: Not providing enough detail in the patient’s medical records to support the use of the code.
  • Overcoding: Using CPT code 99203 when a less complex code would work, leading to potential audits and penalties.
  • Mismatched Coding: Inconsistencies between the documented care and the billed code can result in claim rejections or denials.

Avoiding these mistakes ensures compliance, optimizes reimbursement, and sustains patient satisfaction.

To make sure you don’t end up with penalties or rejected claims, try:

CPT Code 99203 vs. 99204 vs. 99205

Understanding the differences between the new patient CPT codes is key for accurate billing:

  • CPT Code 99203: For new patients requiring detailed exams with low complexity medical decision-making.
  • CPT Code 99204: Used for new patients needing a comprehensive examination with moderate complexity medical decision-making.
  • CPT Code 99205: Appropriate for new patients requiring a comprehensive examination and high complexity medical decision-making.

Choosing the correct code from these options depends on the complexity of the case and the encounter time.

Check out the following table for a more in-depth look:

CodeHistory/ExamMDMEncounter Time (minutes)Reimbursement Rate (2024)
99203Medically appropriate history and/or examinationLow30-44$111.51
99204Medically appropriate history and/or examinationModerate45-59$167.10
99205Medically appropriate history and/or examinationHigh60-74$220.36
From CMS

Conclusion

For plastic surgery and dermatology revenue cycle management, mastering the nuances of CPT code 99203 is not just about billing – it’s a fundamental aspect of providing high-quality patient care and enhancing operational efficiency. 

At The Auctus Group, we understand the importance of accurate and effective client interactions, and we strive to provide resources that help our clients thrive in the competitive healthcare environment. 

With precise use of codes like 99203, you can improve your practice’s service quality, optimize billing processes, and ultimately, enhance patient satisfaction. 

FAQs

What is the difference between 99213 and 99203?

CPT code 99213 is used for an established patient office or other outpatient visit, requiring a low to moderate level of medical decision-making and typically spending 20-29 minutes with the patient. CPT code 99203, on the other hand, is for a new patient visit, requiring a low level of medical decision-making and typically spending 30-44 minutes with the patient.

What is the difference between CPT code 99204 and 99203?

CPT code 99204 is used for a new patient office or other outpatient visit, requiring a moderate level of medical decision-making and typically spending 45-59 minutes with the patient. CPT code 99203 requires a lower level of medical decision-making and typically involves 30-44 minutes with the patient.

What is the reimbursement rate for 99203?

Currently, the Medicare reimbursement rate for 99203 is $111.51. It’s important to check with specific payers for exact rates and changes.

When to use CPT code 99203?

CPT code 99203 should be used for a new patient office or other outpatient visit that requires a low level of medical decision-making. This code is appropriate when the visit typically involves 30-44 minutes of face-to-face time with the patient.

Does 99203 need a modifier?

CPT code 99203 does not typically require a modifier unless there are specific circumstances that necessitate its use, such as billing for multiple services during the same visit. In such cases, modifiers like 25 or 59 may be applicable.

How much does a 99214 pay?

Currently, the CPT code 99214 Medicare reimbursement is $128.16. It’s always smart to check with specific payers for the most accurate rates, especially with updates to the codes happening frequently.

When should modifier 22 be used?

Modifier 22 should be used when the work required to provide a service is substantially greater than typically required. This modifier indicates that the physician or provider performed significantly more work, which should be clearly documented to justify the use of modifier 22 for additional reimbursement consideration.

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