CPT Code 99213: E/M Office Visit, Established Patient, Low Complexity
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
CPT 99213 reports a low-complexity E/M visit for an established patient, or 20 to 29 minutes total time.
When to use CPT 99213
Use for a focused problem visit in an established patient with low MDM or 20 to 29 minutes total time.
Documentation requirements
- MDM or total time
- Medically appropriate history and exam
Reimbursement
$70 to $100
National averages only. Rates vary by locality, payer, and fee schedule. Verify with your contracted payers.
Common modifiers
- -25
Common denial reasons for CPT 99213
- Insufficient documentation for level
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