E/M New · CMS status A
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.
Work RVU
1.60
2026 Medicare pays
$117.57
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 1.60 + Practice 1.76 + Malpractice 0.16 = 3.52 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99203 is locked
- When to use it: the exact clinical situations that support billing 99203
- Documentation checklist: the 5 elements your note needs before submitting
- Common pitfalls: the 5 mistakes that get 99203 downcoded or denied
Start your free 3-month trial →Every new account gets full Pro Max access for 3 months. No card needed.
Common modifiers
2595
Common ICD-10 pairings
Z00.00J06.9I10E11.9
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.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.