Office o/p new low 30 min
CPT 99203 is used when a doctor sees a new patient in the office for a straightforward medical problem that requires low-level medical decision making and typically takes 30-44 minutes.
This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Choose between medical decision making (MDM) and time-based coding by documenting both and selecting the most favorable method
Impact: Can increase revenue by 15-25% when time exceeds 30 minutes but MDM doesn't clearly support level 3; alternatively prevents downcoding when MDM is solid but visit was brief
For time-based coding, document total time on date of encounter including care coordination, documentation, and independent interpretation - not just face-to-face time
Impact: Expands billable time by average of 8-12 minutes per visit, supporting appropriate level selection
Verify new patient status - patient must not have received professional services from same physician/specialty within past 3 years
Impact: Billing 99203 instead of established 99213 inappropriately risks $30.76 overpayment recoupment plus penalties
Document at least 2 of 3 MDM elements for low complexity: limited problem complexity (2 self-limited/minor or 1 stable chronic), limited data review (category 1 only), or low risk complications
Impact: Prevents downcoding to 99202 which pays $30.26 less ($109.01 vs $78.75)
When billing with modifier 25 same day as a procedure, document the separate nature of the E/M and ensure it addresses a different diagnosis or significantly exceeds pre/post-procedure work
Impact: Preserves full $109.01 reimbursement that would otherwise be denied as bundled
Use place of service code 11 for office visits to receive non-facility rate; POS 22 (hospital outpatient) triggers lower facility rate
Non-facility setting pays $29.76 more per visit ($109.01 vs $79.25)
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