2025 CPT code 99213
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Office or Other Outpatient Services Evaluation and Management Feed
Established patient office or other outpatient visit, requiring a medically appropriate history and/or examination and low level of medical decision making. Total time on the date of encounter must be 20 minutes or more.
Modifiers may be applicable to further specify the services provided.
Medical necessity must be established for all services billed.The documentation should support the reason for the visit and the medical necessity of the services provided.
The physician performs an evaluation and management (E/M) service for an established patient.The total time spent on the date of the encounter is 20 minutes or more, or the level of medical decision making (MDM) is low. The provider determines the extent of history and/or physical exam, which do not affect code selection.
In simple words: This code represents a visit to a healthcare provider's office or outpatient facility for an established patient. The visit involves a low-complexity medical decision-making process and/or takes at least 20 minutes of the provider's time on the day of the encounter. This time includes activities like reviewing tests, conducting the exam, patient counseling, ordering tests, and documenting the visit.
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
Example 1: An established patient presents with a stable chronic condition, like hypertension, for a routine follow-up. The provider reviews the patient's medication list, checks their blood pressure, and discusses lifestyle modifications. The encounter lasts 25 minutes., An established patient comes in with a simple acute issue, like a cold. The provider takes a brief history, performs a limited exam, and recommends over-the-counter medications. The encounter lasts 20 minutes., An established patient with diabetes requires a follow-up appointment. The provider reviews recent blood sugar logs, discusses medication adherence, and provides education on foot care.The visit lasts for 22 minutes.
Documentation should support the level of service provided. If using time for code selection, total time spent on the date of encounter should be documented. This includes face-to-face and non-face-to-face time related to the encounter.The medical record should also reflect the medical necessity of the visit, history, exam (if performed), MDM, and any counseling or education provided.
- Specialties:Family Medicine, Internal Medicine, Pediatrics, Geriatrics, and other specialties providing office or outpatient services.
- Place of Service:Office, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, and other outpatient settings.