99203 CPT Code (2026): New Patient, Low MDM

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• 99203

99203 CPT Code (2026): New Patient, Low MDM

CPT code 99203 for new patient office visits with low complexity MDM. Billing rates, documentation, and behavioral health use cases.

Quick Reference

Code

99203

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

7 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 99203: New Patient Office Visit

CPT code 99203 describes an office or other outpatient visit for the evaluation and management of a new patient requiring low complexity medical decision making. With a typical time of 30-44 minutes, this code represents the mid-lower tier of the new patient E&M code series and is frequently used in behavioral health settings where new patients present with manageable but not trivial clinical concerns.

Definition and Purpose

CPT 99203 is part of the office/outpatient E&M code family (99202-99215) for new patients. Under the current E&M guidelines, providers select the code level based on either the complexity of medical decision making or the total time spent on the date of the encounter.

For 99203, low complexity medical decision making is defined across three elements:

Two of the three elements must meet the low complexity threshold for the overall MDM to qualify as low complexity.

Alternatively, 99203 may be selected based on total time of 30-44 minutes spent on the date of the encounter. This includes all physician or qualified health professional time whether or not the patient is present.

• Number and complexity of problems: Two or more self-limited or minor problems, or one chronic illness without severe exacerbation, or one undiagnosed new problem with uncertain prognosis
• Amount and complexity of data: Limited data to be reviewed and analyzed (for example, ordering or reviewing tests, obtaining records from an external source, or reviewing prior notes)
• Risk of complications: Low risk of morbidity from additional diagnostic testing or treatment (such as over-the-counter medications, minor surgery without identified risk factors, or physical or occupational therapy)

When to Use 99203 in Behavioral Health

In behavioral health treatment centers and outpatient practices, CPT 99203 is appropriate for new patient encounters that involve a moderate level of evaluation. Common scenarios include:

• New patient intake assessments where the patient presents with a previously diagnosed mood disorder or anxiety disorder that is currently stable, requiring review of prior treatment history and development of an initial care plan
• Substance use disorder evaluations for new patients with a single substance use concern and a relatively clear treatment path, such as referral to an outpatient program
• Initial medication management visits where a new patient is being evaluated for pharmacotherapy for a condition like mild-to-moderate depression, requiring review of prior medication trials and basic lab orders
• Initial behavioral health consultations where the provider assesses a new patient referred from primary care for a focused concern such as insomnia or adjustment disorder
• Intake evaluations for new patients entering partial hospitalization or intensive outpatient programs where clinical complexity is limited to one or two identified problems
• Follow-up on referral where a new patient presents with records from a referring provider that require review, but the clinical situation is relatively straightforward

Distinguishing 99203 from Adjacent Codes

Accurate code selection is essential for compliance and appropriate reimbursement. Here is how 99203 compares to neighboring codes:

Documentation Requirements

To support a claim for 99203, the medical record must demonstrate either low complexity MDM or 30-44 minutes of total time.

For MDM-based billing, document:

For time-based billing, document:

Behavioral health-specific documentation tips:

• Chief complaint and history of present illness
• At least two self-limited or minor problems, or one chronic condition without exacerbation, or one undiagnosed new problem with uncertain prognosis
• Limited data review, such as ordering a test, reviewing external records, or noting results of prior evaluations
• Low-risk management decisions, including any medications prescribed, therapies recommended, or referrals made
• A clear assessment for each problem addressed
• A treatment plan that corresponds to the documented problems

• A statement that total time is the basis for code selection
• Total time spent on the date of the encounter (30-44 minutes)
• Activities performed, which may include preparing to see the patient, obtaining or reviewing separately obtained history, performing the examination, counseling and educating the patient, ordering medications or tests, documenting in the medical record, and coordinating care
• Clinical assessment and plan

• Include validated screening scores when used (PHQ-9, GAD-7, AUDIT, DAST-10) as these support data review
• Document risk assessment findings, as these contribute to the risk element of MDM
• Note coordination with other treatment team members or external providers
• Describe the patient’s treatment history and any prior medication trials reviewed

Billing and Reimbursement

Billing Process

• Confirm new patient status. Verify the patient has not received professional services from the provider or a same-specialty provider in the same group within the past three years.
• Assess MDM complexity or total time. Determine whether the encounter meets low complexity MDM criteria or falls within the 30-44 minute time range.
• Document the encounter. Complete all required documentation elements before claim submission.
• Assign diagnosis codes. Select ICD-10-CM codes that accurately reflect the conditions addressed and support medical necessity.
• Apply place of service and modifiers. Use the correct POS code and any required modifiers (such as modifier 95 for telehealth ).
• Submit the claim. Bill 99203 with supporting documentation available for audit if requested.

Reimbursement Rates

As of March 2026, approximate reimbursement rates for CPT 99203 are:

These figures are approximate and subject to annual updates by CMS and individual payers. Verify current rates with your specific payer contracts and geographic adjusters.

• Medicare: Approximately $110 (national average; geographic locality adjustments apply)
• Medicaid: Varies by state, typically comparable to or below Medicare rates
• Commercial payers: Generally 120-160% of Medicare rates depending on the negotiated contract

Common Modifiers

The following modifiers are frequently used with CPT 99203:

• Modifier 25 — Significant, separately identifiable E&M service on the same day as a procedure. Use when a billable procedure is performed during the same encounter, and the E&M service is documented separately with its own assessment and plan.
• Modifier 95 — Synchronous telehealth service via real-time interactive audio and video. Required by many payers when the encounter is conducted remotely.
• Modifier GT — Via interactive audio and video telecommunications. Some payers use GT instead of or alongside modifier 95.
• Modifier 33 — Preventive service. May apply when the encounter includes a preventive screening component mandated by payer policy.

Compliance Considerations

Key Requirements

• Medical necessity. The diagnosis codes submitted with the claim must justify the encounter. Document clinical rationale for the visit and the problems addressed.
• Accurate MDM assessment. Ensure the documented MDM genuinely meets the low complexity threshold. Over-reliance on templated notes without individualized clinical detail is a common audit finding.
• Time accuracy. When billing based on time, document actual time spent. Do not estimate or round up beyond the actual time.
• New patient verification. Systematic verification of new patient status prevents billing errors that can trigger audits.

Common Pitfalls

• Routine use of one code. Billing 99203 for all new patient visits regardless of complexity is a red flag for auditors. Code selection should vary based on the individual encounter.
• Insufficient problem documentation. For low complexity MDM, at least two self-limited or minor problems (or equivalent) must be clearly documented. A single vague complaint without supporting detail does not meet this threshold.
• Missing data element. If you review external records or order tests, document this explicitly. Implicit data review does not satisfy the data element requirement.
• Template overreliance. Using identical templated language across all new patient encounters suggests documentation does not reflect the actual visit and increases audit risk.

Related Billing Codes

• 96372
• 99201
• 99202
• 99204
• 99205
• 99211

Reference tables

Common questions

Official sources

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