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CPT code 99203: What to know about low-complexity new patient visits

Adam Morris, CPC

November 6, 2026

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Adam Morris, CPC

Certified Professional Coder by the American Academy of Professional Coders

CPT code 99203 is the evaluation and management (E/M) code for a new patient office visit with low-complexity medical decision making (MDM) or 30–44 minutes of total time. It is the new-patient counterpart to CPT 99213; like the other new-patient E/M codes, it pays more than its established-patient counterpart: about $118 nationally under the 2026 Medicare Physician Fee Schedule, compared with about $95 for 99213.

This guide covers how CPT 99203 is defined, how intake work contributes to MDM and time criteria, and how 99203 is distinct from neighboring codes 99202 and 99204 in the E/M code family.

What is CPT code 99203 used for?

The AMA defines CPT 99203 as an office or other outpatient visit for the evaluation and management of a new patient. The visit must require a medically appropriate history or examination and a low level of MDM. When time is used for code selection, 30 minutes must be met or exceeded on the date of the encounter.

Typical 99203 encounters include a new patient with an uncomplicated urinary tract infection or simple sprain, or a patient establishing care with one well-controlled chronic condition.

The code can only be used if the patient has not received services from the same physician or another physician of the same specialty and subspecialty at the same group within three years.

Two pathways: medical decision making vs. time

Providers may select 99203 based on either low-complexity MDM or total time. Either pathway supports the code.

Pathway 1: Low-complexity MDM

The encounter must meet at least two of three elements at the low level:

1. Number and complexity of problems addressed, met by any one of:

Two or more self-limited or minor problems
One stable chronic illness
One acute, uncomplicated illness or injury

2. Amount and complexity of data reviewed and analyzed, met by either category:

Category 1 (tests and documents): Any combination of two of the following: review of prior external notes from each unique source, review of the result of each unique test, or ordering of each unique test.
Category 2 (independent historian): Assessment requiring an independent third party, such as a parent or caregiver.

3. Risk of patient management: Low risk of morbidity from additional diagnostic testing or treatment, such as over-the-counter medication or physical therapy.

Pathway 2: Total time

Total time must be at least 30 minutes on the date of the encounter, counting face-to-face and non-face-to-face work by the physician or qualified health care professional (QHP). Time spent by clinical staff, such as a medical assistant taking the intake history, does not count. The total must be documented in the note.

How new-patient intake work counts toward 99203

Three features of a first visit map directly to the data element:

Outside records. Notes from a referring or prior provider count as review of prior external notes, once for each unique source.
Independent historians. New pediatric patients and patients with cognitive impairment often need a parent or caregiver to supply their medical history. That alone satisfies the data element at the low level.
Baseline testing. Each unique test ordered counts once; the later review of its result is included in the order, not counted again.
Prior authorization: Prior authorization work belongs here too. According to the AMA's October 2024 CPT Assistant, prior-authorization activities performed by the physician or QHP are part of the described work of 99203–99205, but not 99202. Time the physician or QHP spends on them on the date of the visit counts toward total time; time spent by clinical staff does not.

CPT 99203 vs. 99213

The MDM requirements are identical for 99203 and 99213. The 10-minute difference in time reflects the extra work of a first visit. A 25-minute new-patient visit does not meet 99203 by time, but may still support it by MDM.

CPT 99203 vs. 99204: The establish-care visit

The line between low and moderate MDM is often crossed during visits where a patient is establishing care. Two stable chronic illnesses, such as controlled hypertension and controlled type 2 diabetes, meet the problems element at the moderate level. Deciding to continue, adjust, or stop a prescription medication is prescription drug management, which is moderate risk.

A new patient with two stable chronic conditions whose prescriptions the provider manages therefore meets two of three moderate elements and supports CPT 99204, not 99203. So does a documented total time of 45 minutes or more.

Common billing mistakes for CPT 99203

Not scoring outside records: Reviewed notes from each unique external source count toward data; unscored, they leave the visit a level too low.‍
Double-counting tests: Ordering a test and later reviewing its result is one data point, not two.‍
Counting staff time: Intake time spent by a medical assistant or nurse cannot be added to the physician's or QHP's total time.‍
Billing 99203 for an established patient: A visit with any same-specialty clinician in the group within three years makes the patient established.

Documentation best practices

A defensible 99203 note shows:

Each problem addressed and its status (for example, "stable" or "acute, uncomplicated")
Each unique external source reviewed, named in the note
The identity and role of any independent historian
The management chosen and why its risk is low
When time is used, the total minutes and the work performed on that date

How to ensure accurate billing for CPT 99203

New-patient leveling errors tend to run in one direction: downward. Providers who score only the problem and the prescription often fail to account for the data work of a first visit, so visits that support a higher level get billed lower. Across a high volume of new-patient encounters, that becomes measurable lost revenue.

Pre-billing AI chart review evaluates every note before the claim goes out. Models trained on AMA guidelines can identify 99203 notes whose problems and prescription management support 99204, and 99203 claims on patients the group has seen within three years.

Frequently asked questions

What is CPT code 99203?

CPT 99203 is a new patient office or outpatient visit that requires low-complexity medical decision making or at least 30 minutes of total time on the date of the encounter.

How many minutes is CPT 99203?

When selected by time, 99203 requires at least 30 minutes of total physician or QHP time on the date of the visit. Time spent on another date does not count.

What is the difference between 99203 and 99204?

99203 requires low MDM or 30 minutes; 99204 requires moderate MDM or 45 minutes. Prescription drug management, two stable chronic illnesses, or a chronic illness that is worsening usually moves a visit to 99204.

Does reviewing a new patient's old records count toward the code level?

Yes. Review of prior external notes counts toward the data element of MDM, once for each unique source. When the review happens on the date of the visit, the physician's time spent on it also counts toward total time.

What is the 2026 Medicare reimbursement rate for 99203?

The 2026 national Medicare payment for 99203 is approximately $118 in a non-facility setting, before geographic adjustment.

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