What level of visit is 99213?
Asked by: Khalil Abbott | Last update: July 10, 2025Score: 4.2/5 (37 votes)
What level of service is 99213?
The 99213 CPT code represents a medical evaluation and management (E/M) service provided by physicians. This code is used to document and bill for a level three office visit, which involves a face-to-face encounter with the patient for the evaluation and treatment of a new or existing problem.
What constitutes a 99213 office visit?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making.
What is a level 3 doctor office visit?
Level-III visits are considered to have a low level of risk. Patient encounters that involve two or more self-limited problems, one stable chronic illness or an acute uncomplicated illness would qualify.
What is the difference between a 99213 and a 99214 visit?
The primary difference between CPT code 99213 and 99214 lies in the complexity and time involved. While 99213 is for a low level of medical decision-making, 99214 is used for moderate complexity, requiring a higher level of medical decision-making and more extensive history and examination.
What is a level 3 or 2 office / outpatient visit in medical coding? 99213 & 99203 explained
What constitutes a 99214 visit?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making.
Is CPT code 99213 preventive?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
What is considered a level 4 office visit?
That means that for an outpatient E/M office visit to be coded as a level 4 (for new or established patients), you need at least two of the three elements to reach the “moderate” category — moderate number and complexity of problems addressed; moderate amount and/or complexity of data to be reviewed and analyzed; or ...
What does level 4 mean?
Level 4 on an assessment scale typically indicates a high level of proficiency or mastery in a particular subject.
What is a level 2 office visit?
This code describes a level 2 new patient visit that requires a low level of medical decision-making. The typical time for this visit is 20 minutes. Documentation requirements for new patient CPT code 99202 are as follows: History: Expanded problem-focused history. Exam: Expanded problem-focused exam.
Can 99213 be billed for telehealth?
These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
What is an example of a 99213 visit?
An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.
What are the rules for 99213?
- Medical Necessity: Healthcare providers need to explain why the visit was needed. ...
- Time-based Documentation: Providers need to spend 20-29 minutes with the patient, which is surely required to help them with decision-making.
What is a Level 5 office visit?
Level 5 visits (code 99205) require a high level of medical decision-making and number and complexity of problems addressed (ie, one or more chronic illnesses with severe exacerbation progression or side effects of treatment or one acute or chronic illness that poses a threat to life or bodily function), an extensive ...
What does office visit level 3 mean?
When determining the level of service for office visits involving acute illnesses, here's what to remember: Uncomplicated acute illnesses, such as urinary tract infections (UTI), sinusitis, or sore throat are usually level 3 problems. If you do not treat them, they will not usually result in hospitalization or death.
What is level 4 and level 5?
Level 4 and 5 qualifications
Examples include, but are not limited to, foundation degrees, Certificates of Higher Education (CertHE), Diplomas in Higher Education (DipHEs), Higher National Certificates (HNCs), Higher National Diplomas (HNDs), professional qualifications, and National Vocational Qualifications (NVQs).
What is the difference between Level 3 and Level 4?
Level III: Resists rifle rounds, specifically 7.62mm FMJ lead core rifle ammunition. Level IV: The highest NIJ body armor level, designed to withstand armor-piercing rifle rounds.
What is service code 99213?
CPT Code 99213 Description:
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components to be present in the medical record: An expanded problem focused history. An expanded problem focused examination.
What is the difference between Level 3 and Level 4 E&M?
The difference between a level 3 and 4 E/M code is that two out of the three components of the E/M (problem, data, risk) must meet or exceed a low level of complexity for a level 3, or a moderate level of complexity for a level 4.
What is the difference between 99213 and 99214?
This code is applied when a patient's care involves moderate complexity, such as managing multiple medical conditions or addressing more serious symptoms. The reimbursement rate for this CPT code is higher than 99213 because it includes face-to-face time spent between patient and physician.
How much does 99213 pay?
Medicare physician fee schedule for 2016 for a non-facility CPT code of 99213 ranges from $60.96 to $93.91, with Hawai'i being paid $77.86.
What is the difference between preventive visit and office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.
What modifier to use with 99213?
Get to know them
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.