CPT 99213: Established Patient Office Visit, Level 3
CPT 99213 is a level 3 established patient office visit. How the level is selected, by medical decision making or by time.
Billing 99213 Correctly
CPT 99213 is a level 3 established patient office visit. How the level is selected, by medical decision making or by time.
Source: AMA CPT and CMS billing guidance, verified 2026-09-11
99213 in Detail
CPT 99213 reports an established patient office visit at a low level of medical decision making. It is the most commonly billed office visit code in the United States, and the most commonly defaulted to out of habit.
The level can be selected either by medical decision making or by total time on the date of the encounter, and documentation must support whichever basis was used. Practices that report this level reflexively both undercode their complex visits and overcode their simple ones. The next level up is 99214. Level selection is covered in E/M coding and applied every day in primary care billing.
Using 99213 Correctly
Documentation Requirements
Ensure clinical notes clearly support the level of service, procedure performed, and medical necessity for this CPT code.
Modifier Requirements
Determine whether any modifiers are required for this code, particularly in bilateral, assistant surgeon, or multiple procedure scenarios.
Payer-Specific Rules
Check payer fee schedules and coverage policies, as reimbursement and coverage rules for this code vary by payer.
Bundling Considerations
Review NCCI edits to confirm this code is not bundled with other procedures billed on the same date of service.
99213 Reference
| Field | Details |
|---|---|
| CPT Code | 99213 |
| Official Descriptor | Established patient office or other outpatient visit, low level of medical decision making. |
| Time Reference | Where time is used to select the level, this code corresponds to 20 or more minutes of total time on the date of the encounter. |
| Two Ways to Select the Level | Either medical decision making or total time on the date of the encounter. Whichever is used, the documentation must support it. |
| What Counts as Total Time | Total time on the date of the encounter includes both face-to-face and non-face-to-face work performed by the reporting physician on that day. |
| Most Common Error | Habitual coding, where a practice reports 99213 by default regardless of the work performed. This undercodes complex visits and overcodes simple ones, and both distort revenue. |
| Related Codes | 99212 is the straightforward level and 99214 is the moderate level. New patient visits use the 99202 to 99205 range. |
Source: AMA CPT and CMS billing guidance, verified 2026-09-11
99213, Frequently Asked Questions
Established patient office or other outpatient visit, low level of medical decision making.
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