CPT Code 99203: New Patient Office Visits (Updated 2026)

CPT Code 99203 is defined as: “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 level of medical decision-making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.“

This code is part of the E/M category and applies to new patient visits where the provider performs a detailed assessment, reviews relevant medical history, conducts an appropriate examination, and makes low-complexity medical decisions.

Key Features of CPT Code 99203

Here are the key features of CPT code 99203, which is used for new patient office visits involving low-complexity medical decision-making and a time-based selection of 30–44 minutes.

• Office or other outpatient visit: This means the patient is seen in a doctor’s office, clinic, or similar setting. It can even include telehealth visits.
• New patient: This is key! A new patient is someone who hasn’t seen the same doctor or another doctor of the same specialty in the same group practice within the last three years.
• Evaluation and management (E/M): This refers to the work the doctor does to figure out what’s wrong and how to treat it. It includes talking to the patient, doing an exam, and making decisions about their care.
• Medically appropriate history and/or examination: The doctor needs to get enough information about the patient’s health and do an exam that makes sense for what’s going on.
• Low level of medical decision-making: This means the problem isn’t too complicated. It might be a new, simple issue, a stable chronic condition, or a couple of minor problems.
• 30-44 minutes of total time: If the doctor chooses to bill based on time, they need to spend between 30 and 44 minutes on the patient’s care that day. This includes both the time they spend directly with the patient and any other time they spend on their case, like reviewing records or ordering tests.

Remember, the rules for E/M codes changed in 2021. Now, you can choose the code based on either the level of medical decision-making or the total time spent.

What Kind of History and Exam are Needed for CPT 99203?

For CPT code 99203, the doctor needs to get a “medically appropriate history and/or examination.” This means they should ask questions and do an exam that is relevant to the patient’s health problem.

While the exact number of questions or exam steps isn’t as important as it used to be, the doctor should still document:

• The main reason the patient is visiting (chief complaint).
• Details about the patient’s current problem (history of present illness).
• A review of different body systems to check for other issues (review of systems).
• Information about the patient’s past health, family health, and social habits (past, family, and social history).
• What the doctor found during the physical exam.

The level of detail in the history and exam should match the complexity of the patient’s problem. For code 99203, it’s usually a detailed history and a detailed exam.

How Much Time Should the Doctor Spend?

If the doctor chooses to bill based on time, the total time they spend on the patient’s care on the day of the visit needs to be between 30 and 44 minutes for CPT 99203. This time can include:

• Preparing for the visit by looking at the patient’s records.
• Talking to the patient and doing the exam.
• Counseling and educating the patient.
• Ordering medications or tests.
• Referring the patient to another doctor.
• Documenting the visit in the patient’s chart.
• Reviewing test results and talking to the patient about them.
• Coordinating the patient’s care.

If the doctor bills based on time, they need to document how much total time they spent.

Step-by-Step Guide to Billing CPT Code 99203

Here’s a simple process to follow when billing CPT code 99203:

1. Check if the patient is new: Make sure the patient hasn’t been seen by the same doctor or a doctor of the same specialty in your group within the last three years.
2. Review the doctor’s notes: See if the notes show a medically appropriate history and/or examination for the patient’s problem.
3. Assess the medical decision-making or time: Decide if the problem is of low complexity. If billing by time, check if the total time spent was 30-44 minutes.
4. Use CPT code 99203: If everything lines up, use this code on the claim.
5. Add the right diagnosis codes: Include the ICD-10 codes that explain why the patient was seen.
6. Send the claim: Submit the claim to the insurance company.
7. Keep an eye on the claim: Track the claim to make sure it gets paid. If there are any issues, fix them quickly.

Billing for Telehealth Visits with Code 99203

You can typically use CPT code 99203 for telehealth visits with new patients. However, depending on the insurance company, you might need to use specific rules or modifiers. Always check with the payer to ensure you’re following their guidelines for telehealth billing.

Conclusion

Getting CPT code 99203 right is a key part of medical billing. By understanding what the code covers, who qualifies as a new patient, what documentation is needed, and the common billing rules, you can help ensure your practice gets paid accurately for the important work you do. Stay informed, pay attention to detail, and keep the lines of communication open with your providers to make the billing process as smooth as possible.