CPT 99203 is an office or outpatient visit for a new patient that requires a low level of medical decision making, or at least 30 minutes of the provider’s total time on the date of the visit. It fits a new patient with a straightforward problem, such as one stable chronic condition or a minor acute illness.
CPT 99203 description
99203 is a new patient office or other outpatient visit with a medically appropriate history and/or examination and a low level of medical decision making. When time is used to choose the level, 30 minutes must be met or exceeded.
Who counts as a new patient?
Under CPT, a new patient has not received any professional services from the physician or other qualified health care professional, or from another physician or professional of the exact same specialty and subspecialty in the same group practice, within the past three years. Medicare generally treats a nurse practitioner or physician assistant who works with a physician as the same specialty as that physician. If the patient is established, the matching code is 99213.
New patient levels at a glance
| New patient code | Medical decision making | Or total time on the date of the visit |
|---|---|---|
| 99202 | Straightforward | 15 minutes or more |
| 99203 | Low | 30 minutes or more |
| 99204 | Moderate | 45 minutes or more |
| 99205 | High | 60 minutes or more |
Low medical decision making: what supports 99203
Two of the three elements must reach at least low:
| Element | Low (99203 / 99213) |
|---|---|
| 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 |
| 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 |
| Risk of patient management | Low risk of morbidity from further testing or treatment |
Typical 99203 visits
- A new patient establishing care with one stable chronic condition, such as controlled hypothyroidism, with labs reviewed.
- A new patient with a minor acute problem, such as a sprain, managed with rest and over-the-counter medication.
- A new patient with two minor problems handled together.
If the visit also involves a prescription change for a condition that is not at goal, or two or more chronic conditions, compare it with 99204.
Billing 99203 by time
Count the practitioner’s total time on the date of the visit, including:
- 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
Frequently asked questions
What is the difference between 99203 and 99213?
Both need low MDM. 99203 is for new patients and needs 30 minutes when billed by time; 99213 is for established patients and needs 20 minutes.
Can 99203 be billed by telehealth?
Yes, with payers that cover new patient telehealth visits. See our POS 02 vs. POS 10 guide for the place of service.
Related guides
- CPT 99213: low-complexity established visit
- 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 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.
New patient levels inconsistent?
We review your new patient visits and show you where 99203, 99204 and 99205 are supported by the notes.