2025 CPT code 99203
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Office or Other Outpatient Services Evaluation and Management Feed
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 total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
Modifiers may be applicable in certain circumstances, such as when billing for multiple services on the same day.Modifier 25 may be used to indicate a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service.
Medical necessity for this code is determined by the patient's presenting problem and the physician's clinical judgment regarding the need for evaluation and management services.
In simple words: The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management.The visit involves a low level of medical decision-making, and/or the provider spends 30 or more minutes of total time on the encounter on a single date.The provider performs an evaluation and management (E/M) service for a new patient in the provider’s office or in another outpatient setting.Total time spent on the date of the encounter is 30 or more minutes, and/or the level of medical decision making (MDM) involved is low.
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 total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
Example 1: A new patient presents to a physician's office with a complaint of a persistent cough. The physician takes a detailed history, performs a physical exam, and orders basic laboratory tests. The total time spent with the patient is 35 minutes., A new patient visits a specialist for evaluation of chronic lower back pain. The physician reviews the patient's previous medical records, conducts a comprehensive physical exam, and discusses treatment options. The total encounter time is 40 minutes., A new patient with a recent ankle sprain is seen by a physician in an outpatient clinic. The physician takes a focused history, performs a problem-focused exam, and provides instructions for home care. The total time spent evaluating and managing the patient is 30 minutes.
Documentation should include a medically appropriate history and/or physical exam, the total time spent on the date of the encounter, and the complexity of medical decision making.
** As of December 1, 2024, the descriptor for 99203 has been revised to specify that "30 minutes must be met or exceeded" when using total time for code selection. Prior to 2024, the typical time range was 30-44 minutes.
- Specialties:Family Medicine, Internal Medicine, Pediatrics, and various other specialties may utilize this code depending on the patient's condition and the setting of care.
- Place of Service:Office, Outpatient Hospital, or other Ambulatory Facility.