99213
Office o/p est low 20 min
Office or other outpatient visit, established patient, low-level medical decision making OR 20-29 minutes of total time on the date of the encounter.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
Compare 99213 and 99214 using qualifying time or documented MDM. See a worked example and try the free guided E/M tool.
Review the separately identifiable E/M requirement, supporting documentation and payer limits for modifier 25.
Billing guidance for 99213 is locked
- When to use it: the exact clinical situations that support billing 99213
- Documentation checklist: the 5 elements your note needs before submitting
- Common pitfalls: the 5 mistakes that get 99213 downcoded or denied
Payer notes
Medicare and most commercial payers cover 99213 without prior authorization. Some Medicare Advantage plans audit 99213 to 99214 ratios at the practice level; expect a request for chart documentation if your panel-level moderate-complexity rate is high. Commercial payers occasionally apply place-of-service adjustments. For telehealth, verify your contract before billing 99213 with modifier 95 (audio-video) or GT (audio-only) at POS 02 or POS 10.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what 99213 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.