CPT 99203 Description, Billing Rules, & Use Cases
CPT 99203 is used to bill for an office or other outpatient visit with a new patient that requires a low level of medical decision making and/or at least 30 minutes of total time spent on the date of the encounter
This code applies when a physician, nurse practitioner (NP), or physician assistant (PA) evaluates and manages a patient in an office or outpatient setting, typically for problems of low complexity that require more time and clinical effort than CPT 99202.
The visit may include:
- Taking a detailed patient history and performing a medically appropriate examination
- Counseling or educating the patient or caregiver
- Reviewing and ordering laboratory or diagnostic tests
- Documenting the encounter and treatment plan
- Coordinating care with other healthcare professionals
What is CPT Code 99203?
CPT 99203 is an evaluation and management (E/M) billing code for new patient office or outpatient visits that require low-complexity medical decision making or at least 30 minutes of total time spent on the date of the encounter.
This code applies when the provider:
- Reviews a detailed medical history and performs a medically appropriate examination
- Manages one or more problems that are of low complexity
- Spends a minimum of 30 minutes on the visit, including both face-to-face and non–face-to-face activities (such as chart review, ordering tests, documentation, and communicating results)
Examples of services covered under CPT 99203 include:
- Evaluating new or recurring conditions that require more than a straightforward assessment
- Counseling or educating the patient or caregiver in greater detail
- Ordering and interpreting diagnostic tests
- Coordinating follow-up care with other healthcare professionals
Compared to CPT 99202, which is for shorter and simpler visits, CPT 99203 represents a longer encounter with more clinical complexity, but still below the threshold for moderate or high complexity codes.
CPT 99203 Time Thresholds and Code Combinations
CPT 99203 is used to report a new patient office or other outpatient visit when the provider spends at least 30 minutes of total time on the date of the encounter, or when the level of medical decision making is low complexity.
Important to Note:
- The 2024 revision specifies that “30 minutes must be met or exceeded” (replacing the prior 30–44 minute range).
- Total time includes both face-to-face and non–face-to-face activities, such as reviewing patient history, performing the exam, ordering tests, documenting, counseling, and coordinating care.
- Do not bill CPT 99203 if less than 30 minutes are spent or if the complexity of decision making does not meet the criteria for this code.
- For simpler visits, use CPT 99202; for more complex visits requiring 45+ minutes or moderate MDM, use CPT 99204.
When to Use CPT 99203: Common Scenarios and Use Cases
CPT 99203 is appropriate when a physician, nurse practitioner (NP), or physician assistant (PA) sees a new patient in the office or outpatient setting, spends at least 30 minutes on the encounter, and the visit involves low-complexity medical decision making.
Here are examples of how CPT 99203 is used in practice:
Asthma Follow-Up in a New Patient
A family physician allocates time to:
- Review a detailed medical history including prior emergency visits
- Perform a respiratory exam and assess medication use
- Adjust inhaler therapy and provide education on symptom monitoring
Total time: 35 minutes
Billing: 99203
Initial Visit for Type 2 Diabetes Management
A nurse practitioner allocates time to:
- Take a detailed medical and lifestyle history
- Order baseline labs and review results with the patient
- Counsel on diet, exercise, and medication adherence strategies
Total time: 32 minutes
Billing: 99203
Evaluation of New-Onset Migraine Headaches
A physician assistant allocates time to:
- Collect a detailed symptom and family history
- Perform a focused neurological exam
- Recommend initial treatment options and arrange a neurology referral
Total time: 38 minutes
Billing: 99203
CPT 99203 Billing Requirements and Eligibility
CPT 99203 is used to report new patient office or other outpatient visits that involve low-complexity medical decision making or at least 30 minutes of total provider time on the date of the encounter.
These services must meet documentation and eligibility standards for time, patient status, and provider qualifications.
Patient Eligibility Criteria
The patient must:
- Be a new patient (not seen by the same provider group in the past three years)
- Present with one or more problems of low complexity
- Be evaluated in an office or other outpatient setting (not hospital admission, observation, or emergency department)
Provider Requirements
The billing provider must be a:
- Physician (MD or DO)
- Nurse Practitioner (NP)
- Physician Assistant (PA)
The provider must:
- Personally perform the encounter
- Determine the total time spent or the level of MDM
- Document all elements of the service in the medical record
Service Requirements
The encounter must include either:
- 30 minutes or more of total provider time (face-to-face and non–face-to-face tasks such as reviewing records, documenting, counseling, and ordering tests)
OR - Low-complexity MDM (limited number of problems addressed, low risk of complications, limited data to review)
Additional requirements:
- Services must be distinct from other billed encounters on the same date
- Documentation must clearly support either the time threshold or the MDM standard
CPT 99203 vs Related Codes
- 99202 vs 99203: Use 99202 for visits with 15–29 minutes or straightforward MDM. Use 99203 when the visit requires 30+ minutes or low-complexity MDM.
- 99203 vs 99204: Use 99203 when the visit involves 30 minutes or low-complexity decision making. Use 99204 when the encounter requires 45+ minutes or moderate-complexity MDM.
CPT 99203 Billing Documentation Checklist
To support compliant billing for CPT 99203, your records should include the following:
- Clear documentation of at least 30 minutes of total provider time or evidence that low-complexity medical decision making (MDM) criteria were met
- Time logs (if coding by time) that specify:
- Date of encounter
- Activities performed (e.g., chart review, history, exam, counseling, documenting, ordering tests)
- Total duration of time spent by the physician, NP, or PA
- New patient status confirmed, showing no professional service in the last three years by the same provider group
- MDM documentation that demonstrates:
- A low number and complexity of problems addressed
- Limited data reviewed or analyzed
- Minimal to low risk of complications, morbidity, or mortality
- Details of services performed, such as:
- Medically appropriate history and/or physical exam
- Counseling or education provided to patient or caregiver
- Orders for tests or referrals as applicable
- Care coordination activities
- Provider attestation confirming the service was personally performed and all documentation is accurate and complete
- A statement that time counted did not overlap with other billed services, such as preventive visits or additional E/M codes
Common CPT 99203 Billing Mistakes (and How to Avoid Them)
❌ Billing Without 30 Minutes of Documented Time
CPT 99203 requires at least 30 minutes of provider time if coded by time. Anything less should be billed as 99202.
❌ Using 99203 for Established Patients
This code is only for new patient visits. Established patient encounters must be reported with 99211–99215.
❌ Under-Documenting Low-Complexity MDM
When coding by MDM instead of time, documentation must show a low number of problems, limited data, and low risk. Missing detail may lead to downcoding.
❌ Confusing 99203 With 99204
CPT 99203 is for 30 minutes or low-complexity visits. CPT 99204 is reserved for 45 minutes or moderate-complexity. Incorrect selection is a frequent error.
❌ Including Non-Provider Time
Only time spent by a physician, nurse practitioner, or physician assistant counts toward the threshold. Time by medical assistants, RNs, or administrative staff cannot be included.
❌ Incorrect Service Setting
CPT 99203 applies to office or outpatient visits only. Do not use it for inpatient admissions, observation care, or ED visits — those require different E/M codes.
