99203
Office o/p new low 30 min
Office or other outpatient visit, new patient, low-level medical decision making OR 30-44 minutes of total time on the date of the encounter. The CMS 2026 wRVU for 99203 is 1.60. New-patient counterpart to 99213.
When to use it
Use 99203 for a new patient with one acute uncomplicated problem or two minor stable problems, with limited data review and low-risk management. Common patterns: a new patient transferring care with well-controlled hypertension, a new patient establishing primary care with a single uncomplicated chronic condition, or a young adult new patient with a minor acute illness.
Full guidance
A patient is new only if neither you nor any same-specialty colleague in your practice has seen them face to face in the past three years. The three-year rule is firm and audit-tested. Time-based alternative is 30 to 44 minutes of total time on the date of the encounter.
Documentation checklist
- ✓MDM low complexity (limited problems, limited data, low risk), OR 30 to 44 minutes total time.
- ✓Document the new patient status through a comprehensive history-of-present-illness and full review of systems; the 2021 guidelines no longer require these elements for level selection but they support the new-patient narrative.
- ✓Confirm the three-year rule. The threshold is the patient's last face-to-face encounter with you or anyone of the same specialty in your practice group.
- ✓If you billed an IPPE (G0402), AWV (G0438), or Welcome to Medicare visit on the same date, attach modifier 25 to the 99203 and document separately identifiable problem-oriented work.
- ✓Time-based: include all qualifying activities (chart prep, history, exam, ordering, counseling, documentation, care coordination on date of encounter).
Common pitfalls
- !Coding a returning patient as new because they have not been seen recently. If they were seen 35 months ago they are still established. CMS audits this routinely via claims-history matching.
- !Time-based new patient visits often coded incorrectly. Verify the time threshold was actually met; for 99203 it is at least 30 minutes.
- !Failing to bill G2211 when you are the new continuity provider. New patient visits in continuity practices are eligible for G2211 and the add-on is one of the highest-leverage wRVU recoveries available.
- !Up-coding a 99203 to 99204 by including extensive history and exam without supporting MDM. 2021 guidelines removed history and exam from level selection; only MDM and time count.
- !Not documenting establishment as a new patient when the patient was previously seen by a colleague in a different sub-specialty within the same practice. Sub-specialty within the same group is treated as the same specialty under the 3-year rule for some payers but not others; verify your contract.
Payer notes
Medicare and Medicare Advantage plans audit new-patient claims using prior claim history. Commercial payers including Aetna and BCBS occasionally request copies of the prior provider's records to verify true new-patient status. For telehealth new patients, Medicare requires the patient be in their home (POS 10) or another approved originating site (POS 02); commercial payer rules vary.