- Key Takeaways
- CPT code 99203 reports a new patient office visit with low-complexity medical decision making or 30 to 44 minutes of total time on the encounter date.Â
- Since 2021, history and exam no longer set the level for 99203; the code is chosen by low MDM or total time, so detailed-exam habits no longer apply.Â
- Low MDM means two of three elements at the low level, such as one stable chronic illness or two minor problems, with limited data and low risk.Â
- The boundaries matter: a straightforward visit is 99202, and moderate-risk decisions like new prescription drug management move the visit up to 99204.Â
- The AMA counts a problem only when it is evaluated or managed, so a diagnosis merely listed in the history does not raise the MDM level.Â
Of all the new patient office codes, 99203 changed the most in the 2021 evaluation and management overhaul, and it is the one practices are most likely to still code by the old rules. Before 2021, 99203 required a documented “detailed history and examination.” Since January 1, 2021, history and exam no longer set the level at all. 99203 is now defined purely by low-complexity medical decision making or 30 to 44 minutes of total time. Practices that still choose it by counting history and exam bullets end up misplacing it, either under-documenting the decision-making or drifting to the wrong level.Â
Current as of 2026. Always verify code status and payment with your specific payer, since policies change.
What 99203 is: the low-complexity new patient visit
99203 is an office or other outpatient visit for a new patient, supported by low-complexity medical decision making or 30 to 44 minutes of total time on the date of the encounter. It is the Level 3 new patient code, one above 99202 and one below 99204, and historically one of the most commonly billed new patient levels. It fits the straightforward-to-low first visit: a new patient with one stable chronic condition, a couple of minor problems, or a single uncomplicated acute issue.Â
Because it is a new patient code, the 3-year, same-specialty, same-group rule applies, and getting that wrong is its own denial. We cover that in our guide to CPT code 99204.Â
What changed in 2021, and why it matters for 99203
Under the old rules, each E/M level carried a specific history and exam requirement, and 99203 meant a “detailed” history and exam. The 2021 revision removed that entirely. History and exam now only need to be medically appropriate, a matter of clinical judgment, and they no longer determine the code. The level comes from one of two things: low MDM or total time.Â
This is the single most useful thing to understand about billing 99203 correctly today. A note stuffed with a thorough history and a full exam does not, by itself, support 99203 anymore. What supports it is documented low-complexity decision-making or 30 to 44 minutes of time. Coding by the old habit is how practices either lose the level they earned or apply the wrong one.Â
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The low-MDM definition: what actually qualifies
Low MDM means reaching the low level in at least two of three elements:Â
- Problems addressed: two or more self-limited or minor problems, or one stable chronic illness, or one acute uncomplicated illness or injury.Â
- Data reviewed: a limited amount, such as reviewing an external note or a test result, ordering a test, or using an independent historian when needed.Â
- Risk: low risk from the workup or treatment, such as over-the-counter medication management.Â
One important nuance: a problem counts only if it is actually evaluated or managed during the visit. Listing a diagnosis in the history does not make it a problem addressed. A new patient with controlled hypertension whose readings are reviewed and whose plan is continued has a stable chronic illness addressed, which supports the problems element at low.Â
In practice, conditions that commonly support low-complexity MDM when they are actively addressed include essential hypertension (I10), type 2 diabetes without complications (E11.9), and hyperlipidemia (E78.5) as stable chronic illnesses, or an uncomplicated urinary tract infection (N39.0) or acute upper respiratory infection (J06.9) as acute uncomplicated problems. The diagnosis code alone does not set the level, though. What matters is that the problem was evaluated or managed and documented as such.
The two boundaries: 99202 below, 99204 above
99203 lives between two levels, and the lines are worth knowing:Â
- Below it, 99202 is straightforward MDM: minimal problems, minimal or no data, and minimal risk, or 15 to 29 minutes. The step from 99202 to 99203 is the step from minimal to low complexity.Â
- Above it, 99204 is moderate MDM or 45 to 59 minutes. The most common factor that moves a visit from 99203 to 99204 is new prescription drug management, which counts as moderate risk on its own. Our guide to CPT code 99213 covers the same low-complexity level on the established patient side.Â
Documentation payers expect
A defensible 99203 note should show:Â
- That the patient meets the new patient definitionÂ
- A medically appropriate history and examination (documented, but not the basis for the level)Â
- Either two low-level MDM elements, the problems addressed and their status, any data reviewed, and the low risk, or a clear statement of total timeÂ
- A diagnosis linked to the encounter that shows the problem was addressed, not just listedÂ
Common billing errors to avoid
- Coding by old history and exam habits. Since 2021, the level is low MDM or time, not the extent of the exam.Â
- Listing problems instead of addressing them. A diagnosis has to be evaluated or managed to count.Â
- Missing the move to 99204. New prescription drug management pushes the visit to moderate risk and 99204.Â
- Confusing the 99202 floor. A minimal, self-limited visit is 99202, not 99203.Â
- New patient determination errors. Confirm the 3-year, same-specialty, same-group rule before billing a new patient code.Â
Related codes and modifiers
- The new patient ladder: 99202 (straightforward, 15 to 29 minutes), 99203 (low, 30 to 44 minutes), 99204 (moderate, 45 to 59 minutes), 99205 (high, 60 to 74 minutes).Â
- 99203 vs 99213: the same low-complexity level, split by new versus established status, with higher time thresholds and higher payment on the new patient side.Â
- Modifier 25 applies when a significant, separately identifiable E/M is billed with a same-day procedure.Â
- G2211, the Medicare visit-complexity add-on, is billable with 99202 through 99215.Â
Reimbursement context
99203 is paid under the Medicare Physician Fee Schedule and reimburses more than its established counterpart, reflecting the additional work of a new patient encounter. The exact amount depends on setting and locality. Treat any single figure as illustrative and confirm the current rate through the CMS Physician Fee Schedule Look-Up Tool, which updates annually.Â
The bottom line
99203 is a common, low-complexity new patient code that many practices still bill as if it were 2020. Choose it by documented low MDM or 30 to 44 minutes, make sure each problem is addressed and not just listed, and know the lines on either side. For practices that would rather not track E/M levels and new-patient rules claim by claim, Neolytix has supported healthcare organizations across the United States for over 14 years, with E/M coding review built into its medical billing services so new patient claims are accurate before they go out.Â
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This guide reflects Neolytix’s expertise in healthcare revenue cycle management and is intended for educational purposes only. It does not constitute legal or compliance advice. CPT codes and reimbursement rates are periodically updated by the AMA and CMS.
Sources
- American Medical Association. CPT code 99203, new patient office visit, 30 to 44 minutes. https://www.ama-assn.org/practice-management/cpt/cpt-code-99203-new-patient-office-visit-30-44-minutesÂ
- American College of Surgeons. 2021 office and outpatient E/M coding changes and medical decision making. https://www.facs.org/for-medical-professionals/practice-management/coding-and-billing/em-coding-billing/officeoutpatient-em-visit-coding-changes/medical-decision-making/Â
- Centers for Medicare & Medicaid Services. Physician Fee Schedule Look-Up Tool. https://www.cms.gov/medicare/physician-fee-schedule/searchÂ
- AAPC. CPT code 99203 reference. https://www.aapc.com/codes/cpt-codes/99203Â
Frequently Asked Questions
What is CPT 99203 used for?
99203 is a new patient office visit with low-complexity medical decision making or 30 to 44 minutes of total time. It fits a new patient with one stable chronic illness, two or more minor problems, or an acute uncomplicated issue, with limited data reviewed and low-risk decisions. It is one of the most commonly billed new patient codes.
How many minutes is 99203?
On the time pathway, 99203 requires 30 to 44 minutes of total time on the date of the encounter, including chart review, the visit, counseling, coordination, and documentation by the billing provider. Below 30 minutes points to 99202, and reaching 45 minutes moves the visit to 99204.
What is the difference between 99203 and 99204?
Both are new patient office visits, separated by complexity and time. 99203 requires low MDM or 30 to 44 minutes. 99204 requires moderate MDM or 45 to 59 minutes. New prescription drug management is the most common factor that moves a visit from 99203 to 99204, since it counts as moderate risk.
What is the difference between 99202 and 99203?
Both are lower-level new patient visits. 99202 involves straightforward MDM with minimal problems, minimal data, and minimal risk, or 15 to 29 minutes. 99203 involves low MDM, such as one stable chronic illness or two minor problems, or 30 to 44 minutes. The difference is the step from minimal to low complexity.
Can 99203 be billed for telehealth?
Yes. 99203 can be billed for a telehealth new patient visit when it meets the same low MDM or 30 to 44 minute requirement as an in-person visit. Append modifier 95 for audio-video and use the correct place of service. Confirm each payer’s telehealth and new-patient rules, since some limit new patient telehealth.
