99213 CPT Code: Low-Complexity Established Visit

The 99213 CPT code is the routine follow-up for an established patient — a low-complexity office or outpatient evaluation-and-management visit. Since the 2021 guidelines, it is chosen by low medical decision making or 20–29 minutes of total time on the encounter date. In behavioral health it is the steady-state medication check-in for a stable patient, the rung directly beneath the busier 99214.

What is the 99213 CPT code? 99213 is the Current Procedural Terminology code for a low-complexity established-patient office or outpatient E/M visit, supported by low medical decision making or 20–29 minutes of total encounter-date time.

Undeny's Take

99213 is correct far more often than billers fear, and that is the point worth making. The 2021 rules were not just permission to bill higher — they were permission to bill accurately. A genuinely stable patient on a steady medication, seen briefly, is a clean 99213; forcing it to 99214 without moderate decision making or 29-plus minutes invites a clawback. The discipline that protects revenue across a panel is consistency: let documented time or medical decision making choose between 99213 and 99214 every visit, rather than defaulting either way out of habit or fear.

When 99213 Is the Right Code

99213 covers an evaluation-and-management service for an established patient in the office or outpatient setting at a low level of complexity. Since 2021, code selection rests on the level of medical decision making or total time, not the former history-and-exam scoring. For prescribers, it typically represents a straightforward follow-up visit for a stable condition.

The 20-to-29-Minute Threshold

99213 is selected by low medical decision making or by 20–29 minutes of total time on the date of the encounter, including qualifying non-face-to-face work that day. It is a single visit unit rather than a timed 15-minute code. Reimbursement follows each payer's fee schedule — Medicare from the code's RVUs on the Physician Fee Schedule. Use your contracted rate or the CPT estimator for a working figure.

Modifiers for 99213

• 25 — significant, separately identifiable E/M on the same day as a procedure or psychotherapy add-on.
• 95 — synchronous telehealth visit, with the appropriate place of service.
• Psychotherapy add-on codes may accompany the E/M when both services are documented.

Why 99213 Gets Downcoded

• Time or MDM not documented to support the level billed.
• Missing modifier 25 when billed with a same-day procedure or add-on.
• Telehealth modifier or place-of-service mismatch.
• Frequency edits for high-volume follow-up billing.

99213 on the E/M Ladder

99213 is the lower rung of the established-patient E/M ladder. 99214 is the moderate-complexity visit billed when the work or time is greater. Browse the full set under CPT codes.

Frequently Asked Questions

What is required to bill 99213?

99213 requires either low medical decision making or 20–29 minutes of total time on the encounter date. Since 2021, the level is chosen by MDM or time rather than by history-and-exam bullet counts.

What is the difference between 99213 and 99214?

99213 reflects low-complexity decision making or 20–29 minutes, while 99214 reflects moderate-complexity decision making or 30–39 minutes. Choose the code that matches the documented work or time.

Is 99213 a telehealth-eligible code?

Yes, when delivered as a synchronous telehealth visit and the payer permits it. Append modifier 95 and use the correct place-of-service code; confirm each payer's current telehealth policy.

How do I avoid under-coding 99213?

Document time or medical decision making at every visit so the correct level is supported. A stable, brief follow-up is a proper 99213, but a moderate-complexity visit should be billed as 99214 when the records back it up.

Informational only — not legal, medical, or billing advice. Always verify against current CPT guidance and your payer policy.

Estimate 99213 reimbursement

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