CPT 99213 is an office or outpatient visit for an established patient that requires a low level of medical decision making, or at least 20 minutes of the provider’s total time on the date of the visit. It is one of the most frequently billed codes in medicine and fits most simple follow-up visits.
CPT 99213 description
99213 is an established patient office or other outpatient visit with a medically appropriate history and/or examination and a low level of medical decision making (MDM). When time is used to choose the level, 20 minutes must be met or exceeded. Since 2021, history and exam no longer set the level; they only need to be medically appropriate.
Office visit levels at a glance
| Code | Medical decision making | Or total time on the date of the visit |
|---|---|---|
| 99211 | Not required (usually clinical staff) | Not used |
| 99212 | Straightforward | 10 minutes or more |
| 99213 | Low | 20 minutes or more |
| 99214 | Moderate | 30 minutes or more |
| 99215 | High | 40 minutes or more |
Low medical decision making: what supports 99213
The level is set by meeting or exceeding 2 of the 3 MDM elements. The table shows what low (99213) and moderate (99214) look like:
| Element | Low (99213) | Moderate (99214) |
|---|---|---|
| Problems addressed | 2 or more self-limited or minor problems; or 1 stable chronic illness; or 1 acute, uncomplicated illness or injury; or 1 stable acute illness | 1 or more chronic illnesses with exacerbation, progression or side effects of treatment; or 2 or more stable chronic illnesses; or 1 undiagnosed new problem with uncertain prognosis; or 1 acute illness with systemic symptoms; or 1 acute complicated injury |
| Data reviewed and analyzed | At least 1 of: any 2 of reviewing prior external notes, reviewing a test result, or ordering a test (each unique); or an assessment requiring an independent historian | At least 1 of: any 3 of the low-level data items (notes, test results, tests ordered, independent historian); or independent interpretation of a test performed by another provider; or discussing management or a test with an external physician or other appropriate source |
| Risk of patient management | Low risk of morbidity from further testing or treatment | Moderate risk, for example prescription drug management, or a decision about minor surgery with risk factors |
Typical 99213 visits
- Follow-up of one stable chronic condition, such as well-controlled hypertension, with labs reviewed.
- An acute, uncomplicated problem such as a minor sprain, managed with rest and over-the-counter medication.
- Two minor problems handled in one visit.
If the same visit involves prescription drug management and a chronic illness that is not at goal, it may support 99214 instead. See our 99213 vs. 99214 guide.
Billing 99213 by time
Total time is the practitioner’s time on the date of the visit, face-to-face or not. It can include:
- Preparing to see the patient, such as reviewing tests
- Getting or reviewing separately obtained history
- Performing a medically appropriate exam
- Counseling and educating the patient, family or caregiver
- Ordering medications, tests or procedures
- Referring and communicating with other professionals (when not separately reported)
- Documenting in the record
- Independently interpreting results (when not separately reported) and coordinating care
It does not include clinical staff time, travel, or time for separately reported services. Document the total minutes in the note.
Add-ons and modifiers
- G2211 (Medicare): a visit complexity add-on for practitioners who are the continuing focal point of the patient’s care or manage a single serious or complex condition over time. Medicare does not pay it when the visit carries modifier 25, except with an annual wellness visit, vaccine administration or a Part B preventive service.
- Modifier 25: needed when a significant, separately identifiable visit happens on the same day as a minor procedure or preventive visit.
Frequently asked questions
Is 99213 for new or established patients?
Established patients. The new patient code with the same MDM level is 99203.
Can 99213 be billed by telehealth?
Yes, with payers that cover it. See our POS 02 vs. POS 10 guide for the place of service.
Related guides
- CPT 99214: moderate-complexity established visit
- 99213 vs. 99214: how to choose the level
- CPT 99215: high-complexity established visit
- CPT 99204: moderate-complexity new patient visit
- CPT 99203: low-complexity new patient visit
- CPT 99205: high-complexity new patient visit
- CPT 99212: straightforward established visit
- CPT 99202: straightforward new patient visit
- CPT 99211: nurse visit for an established patient
- CPT 99417: prolonged office visit add-on
- Primary care billing services
- Medical coding services
CPT is a registered trademark of the American Medical Association. This guide summarizes the office visit E/M rules in effect since 2021, with the 2024 time wording, and the CMS Evaluation and Management Services guide (MLN006764) (opens in a new tab). Payer policies and your documentation decide what is billable.
Are your visit levels right?
Our certified coders review a sample of your E/M visits and show you where levels are too low or too high.