99213
E/M EstCMS status: AOffice or other outpatient visit, established patient, low-level MDM or 20-29 minutes total time.
Work RVU
1.30
Practice RVU
1.46
Malpractice RVU
0.09
Total RVU
2.85
2026 Medicare payment
$95.19
National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility
Model this code
Drop 99213 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
Stable established patient, one or two minor problems, simple lab review, no medication changes. Examples: stable HTN follow-up, routine refills, simple URI.
Documentation checklist
- ✓MDM: low complexity (limited problems, limited data, low risk), OR total time 20-29 min documented.
- ✓If time-based: must include time spent on date of encounter on care of this patient (chart review, counseling, ordering, documentation).
- ✓Note must support medical necessity, not just time.
Common pitfalls
- !Up-coding to 99214 without supporting MDM or time. CMS audits target this delta.
- !Counting non-billable activities (clinical staff time, time on a different date) toward the time threshold.
- !Billing time + MDM on the same note — pick one method.
Common modifiers
2595
Common ICD-10 pairings
I10E78.5Z00.00
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.