CPT 99203 is an office visit for a patient the practice has not seen in the past three years, of low complexity: a straightforward problem, about 30 minutes of the clinician's time. It is the typical first visit for a minor issue, a medication refill with a new doctor, or a simple referral.
What the price covers
When a hospital lists this code, it is the price for a visit at a hospital-owned clinic or outpatient department. Hospital-owned practices often bill a facility fee in addition to the professional fee, which can make the same visit cost twice what it would at an independent practice. Tests, procedures and imaging ordered during the visit are all separate.
The five new-patient levels
- 99202: about 20 minutes, straightforward
- 99203: about 30 minutes, low complexity (this page)
- 99204: about 45 minutes, moderate complexity
- 99205: about 60 minutes, high complexity
The level is chosen by the clinician after the visit based on complexity or time, so the price you see is the price for that level, not for "a visit".
Why prices vary
Visit prices vary with ownership more than anything else. Independent practices and urgent-care clinics rarely charge facility fees; hospital-owned clinics usually do. Cash prices at hospitals are often well below gross charges.
Questions to ask
- What is the self-pay price for a 99203 visit, and is there a separate facility fee?
- Which visit level will be billed, and what if it is higher?
- Are any tests or procedures included?