99213 CPT Code: Established Patient Visit (20–29 Minutes)

What 99213 Covers

CPT code 99213 is used for an office or other outpatient E/M visit for an established patient. This service qualifies when the provider performs a medically appropriate history and/or physical examination, and the visit involves low-level MDM. 

99213 covers routine follow-up visits for stable chronic conditions, uncomplicated acute illnesses, medication management, reviewing test results, and many more.

When to Use it

Use 99213 when the encounter involves an established patient with limited clinical complexity. This includes a routine follow-up, medication refill, or a brief check-in where no significant management decisions are required.

Here’s how 99213 compares to commonly confused codes:

• 99212 vs. 99213: 99212 requires straightforward MDM or 10–19 minutes. 99213 is appropriate when the visit involves at least one chronic condition and a clinical decision.
• 99213 vs. 99214: A routine stable check-in that reaches 20-39 minutes belongs at 99213. 99214 requires 30–39 minutes, or when a visit involves a complex prescription decision with monitoring.
• 99213 + 90833: A prescribing provider who also delivers 16 to 37 minutes of interactive psychotherapy in the same encounter can append 90833 to 99213. 

Documentation that Keeps it Paid

99213 carries lower audit risk than 99214, but underdocumentation is still a liability. The clinical record must contain this documentation: 

• Problems addressed, their current status, and any clinical decisions made. 
• Data reviewed, labs ordered, or other provider contact made, and any independent interpretation if performed.  
• Prescription management decision at the low-complexity tier. This includes stable medication, no changes, or a minor adjustment with routine monitoring.
• The total time in minutes as a specific figure. Ex: 29 minutes. 

Common Denial and Audit Triggers

• Consistently billing 99213 for a panel where peers bill 99214 can trigger a low-utilization query.
• Notes that list diagnoses but do not show problem complexity, data, or risk at the low level.
• Billing 99213 for a patient who is new to the practice or group.
• A vague reference to a “brief visit” does not anchor the claim to the 20–29 minute range.

Telehealth Billing

99213 is payable via telehealth for Medicare and most commercial plans. Use modifier 95 for real-time audio-video and modifier 93 for audio-only where covered. POS 02 applies when the patient is not in their home, while POS 10 applies for home-based telehealth. 

How 99213 Pairs with Other Codes

99213 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. 

Additionally, it pairs with 99490 and 99491 when those services are delivered on a separate date or by a different provider.

99213 cannot be billed alongside 90791 or 90792 by the same provider on the same date, nor can it be billed with 99212 or 99214 for the same patient and provider. 

Frequently Asked Questions

1. Can I bill 99213 at every session?

Yes, but only if the documentation supports low MDM or 20 to 29 minutes of total time for each encounter.

2. Can I bill more than one unit of 99213 on the same day?

No. Report one E/M code per patient per day for the same provider specialty unless a distinct, separately identifiable service with appropriate modifiers and documentation justifies otherwise.

3.What is the difference between 99213 and 99214?

99213 requires low MDM or 20–29 minutes; 99214 requires moderate MDM or 30–39 minutes.