What is the difference between CPT code 99203 and 99205?
Asked by: Ezekiel Mosciski | Last update: October 24, 2025Score: 4.1/5 (24 votes)
What does CPT code 99205 mean?
99205 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 high medical decision making.
What is CPT code 99203 used for?
CPT code 99203 is used for new patient office visits that require a medically appropriate history and/or examination and a low level of medical decision making. The typical time for a CPT code 99203 visit is 30-44 minutes. Proper documentation of the care components is essential to support billing for this code.
What is the difference between 99203 and 99204?
The difference between CPT code 99203 and 99204 lies in the complexity and time. 99203 is used for visits of low complexity (30-44 minutes), while 99204 is used for moderate complexity (45-59 minutes).
What level of service is 99203?
CPT Code 99203
This code describes a level 3 new patient visit that requires a moderate level of medical decision-making. The typical time for this visit is 30 minutes. Documentation requirements for new patient CPT code 99203 are as follows: History: Detailed history.
CPT 99203, 99204 and 99205 || CPT description
How many minutes is 99205?
You can code based on MDM or time thanks to the changes to E/M coding in 2021, which took out the requirements of typical face-to-face patient visits. A single encounter of 60-74 minutes of total time on the visit date is required to code 99205.
What is CPT code 99203 charge?
The reimbursement rate for CPT Code 99203 under Medicare in 2024 is $111.51. This code is often chosen strategically when providers opt for a lower-level evaluation and management service compared to higher-coded visits like CPT Code 99204 or CPT Code 99205, which offer higher reimbursement rates.
What is the difference between 99203 and 99214?
As you look further down the associated codes, you also find important descriptions like 99214 is an office patient for an established patient. One of the fastest ways to get audited and face adjustments and penalties is to bill a 99203 for an established patient who underwent some inpatient hospital procedure.
Does cpt code 99205 need a modifier?
In addition, the appropriate level of E/M service for an office or other outpatient visit for a new or established patient (99202–99205, 99212–99215) would be reported with modifier 25 appended to indicate that a significant, separately identifiable E/M service was provided.
What is considered a new patient visit?
According to CPT, a new patient is a patient who has not been seen by that physician or another physician or other qualified health care professional of the same specialty in the same group practice in the past three years.
Does Medicare cover code 99203?
99203 Reimbursement for 2024
Generally, Medicare reimbursement for CPT code 99203 is set at approximately $111.51. This rate reflects a standard evaluation and management (E/M) visit for a new patient, involving a medically appropriate history and/or examination and low complexity in medical decision making.
Can you bill an office visit with a cast application?
A charge for procedure codes 29000-29590 is allowed only when the casting or strapping is a replacement procedure used during the period of follow-up care. The charge for an office visit is allowed only if significant identifiable further services are provided at the time of the cast application or strapping.
What is the difference between 99213 and 99203?
If both doctors work for the same practice, *usually* 99203 can be billed only once per practice, then 99213 for any subsequent visits.
Can 99205 be used for telehealth?
Office visit evaluation and management services (CPT codes 99202-99205, 99211-99215) furnished using audio-video telecommunications technology are reported using the same CPT codes as you would have had the visit been conducted in-person.
What pays more, 99205 or 90792?
CPT® 2024 American Medical Association.
A level-four or a level-five new patient encounter will pay out higher than 90792. A level-four new patient non-facility code (99204) will pay out approximately $166.22 while a claim for 99205 will fetch $207.06.
Can you bill a telehealth and office visit on the same day?
E-visits should not be billed on the same day the physician reports an office visit E/M service (CPT codes 99202-99205 and 99211-99215) for the same patient. Additionally, e-visits should not be billed when using the following codes for the same communication: 99091.
What is the difference between 99205 and 99204?
Code 99204 requires a minimum of 45 minutes of face-to-face time with the patient and Code 99205 requires a minimum of 60 minutes face-to-face time with the patient. For both services, at least 50% of the face-to-face time must be spent providing counseling and/or coordination of care.
What is the CPT code for a new patient?
New Patient CPT® Code range 99202- 99205.
What does CPT code 99203?
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.
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.
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
Can a chiropractor bill 99203?
Here is a list of the other most commonly used CPT codes for chiropractors, which include other treatments and appointment types: CPT Code 99202 – Evaluation and Management, Initial Visit. CPT Code 99203 – Evaluation and Management, Initial Visit.
What is the CPT code for outpatient office visit?
Office or Other Outpatient Services CPT® Code range 99202- 99215.