99203 CPT Code: New Patient Visit (30–44 Minutes)

What 99203 Covers

99203 covers new patients who have not received professional services from the physician or any other provider of the same specialty in the same group practice within the past three years. The encounter must meet 30 to 44 minutes in total time on the date of service or low complexity across at least two of three elements: stable chronic illnesses needing assessment, uncomplicated acute conditions, or undiagnosed new problems with a low likelihood of significant complications.

When to use it

Use 99203 for new patients whose problems require low-complexity clinical judgment or when the total time on the date of service meets the 30–44-minute threshold.

Here’s how 99203 compares to related codes:

• 99202 vs. 99203: 99202 requires straightforward MDM or 15 to 29 minutes. 99203 is the step up to low complexity.
• 99203 vs. 99204: 99204 requires moderate MDM or 45 to 59 minutes. 
• 99203 vs. 99213: 99213 is the established-patient equivalent, requiring low MDM. The two codes share the same MDM threshold, but 99203 carries a higher time floor and applies only to new patients. 

Documentation that Keeps it Paid

99203 requires a more substantively detailed note than a follow-up visit. Here’s the note that supports a new-patient E/M level on review:

• Showcase that a new clinical relationship is being established.
• Document the onset and duration of the problem, relevant psychiatric and medical history, current medications, etc.
• Name the conditions addressed, their current status, and the clinical plan. 
• At the low MDM tier, risk should involve over-the-counter medications, minor procedures, or no prescription drug management. 
• Document total time between 30-44 minutes as a specific minute count.

Common Denial and Audit Triggers

• Billing 99203 for an established patient instead of 99213.
• Using 99203 as a default for all new-patient visits when an encounter supports 99204. 
• Total time documented below 30 minutes. 
• New-patient note lacks complete history, clinical formulation, or treatment plan. 
• Billing 99203 alongside 90791 for the same provider and patient on the same date.

Telehealth Billing

99203 is payable via telehealth for Medicare and most commercial payers. Modifier 95 applies for real-time audio-video sessions, while modifier 93 applies for audio-only where covered. POS 02 applies when the patient is not in their home, whereas POS 10 applies for home-based telehealth. 

How 99203 Pairs with Other Codes

99203 can be billed on the same date as psychotherapy add-on code 90833 when a prescribing provider delivers both an E/M service and interactive psychotherapy in the same encounter.

However, 99203 cannot be billed on the same date as 99202 or 99204 for the same patient and provider, nor can it be combined with 90791 or 90792 without confirming payer-specific same-day rules. 

Frequently Asked Questions

What makes a patient new for 99203?

They should not have received professional services from the physician or any other provider of the same specialty in the same group practice within the past three years. 

What is the difference between 99203 and 99213?

99203 is for new patients and requires 30 to 44 minutes of total time. 99213 is for established patients and requires 20 to 29 minutes. 

Can I bill more than one unit of 99203 on the same day?

No. Only one new-patient office visit code is reported per patient per day. Additional services may be reported with appropriate modifiers and supporting documentation.