How to use CPT code 99204
Code 99204 represents a new patient appointment that’s at least 45 minutes in duration.
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How to use CPT code 99204
How to use CPT code 99204
Billing and coding
How to use CPT code 99203
Code 99203 represents a new patient appointment that’s at least 30 minutes in duration.
The 99203 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
CPT code 99203 description
Code 99203 represents a new patient appointment that’s at least 30 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99203 in the official CPT codebook:
CPT code 99203: New patient office visit, minimum 30 minutes
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
As a prescriber, you can bill insurance according to time or medical decision-making (MDM). Make sure to include sufficient documentation to support the method you choose.
If you spent at least 30 minutes with a client but the case was especially complex or high risk, or involved reviewing or analyzing a lot of data, you may use a higher CPT code, including 99204 (moderate MDM), or 99205 (high MDM).
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
99203 vs 99213: New patient vs. existing patient
If you’re treating an existing patient, you should use 99213 instead. A new patient is someone you have not seen in the last three years.
CPT code 99203 time frame
CPT code 99203 documentation
Documentation for 99203 is essentially the same as other E/M codes, but geared toward a new patient.
- Medically appropriate history: Document relevant information about the patient’s presenting complaint, medical history, and any other important factors.
- Medically appropriate examination: Perform and document an evaluation that’s appropriate for the patient’s presenting complaint.
- Low complexity medical decision making: Make a straightforward judgment about the patient’s diagnosis, create a care plan, and prescribe appropriate treatments or interventions.
- If you are billing based on time, include start/stop timers.
Here’s a new patient example note:
Patient Name: Quinn Morales
Date of Service: 03/27/20
Patient DOB: 5/18/1982
Appointment Time: 8:30am-9:00am
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
The total time I spent caring for this patient today was 41 minutes which included: interviewing the client, documenting, reviewing the patient's responses to questionnaires, discussing treatment plans, coordinating care, prescription management and counseling the client on managing her mental health.
Subjective
Chief Complaint: Patient presents with stable ADHD and is here for a medication refill.
HPI: 42-year-old male with a history of ADHD presents for a follow-up to refill his medication. The patient states that his symptoms are well-controlled with Strattera and denies any recent issues or concerns. He reports no significant side effects from the medication and states that his focus and concentration have improved. He denies mood changes, anxiety, or depression.
ROS:
- General: No recent weight changes, no fatigue.
- Cardiovascular: No chest pain or palpitations.
- Neurological: Occasional headaches, no visual disturbances.
PMH/PSH:
- Past medical history: ADHD, well-managed with Strattera.
- Past surgical history: Appendectomy, 2015.
Medications:
- Strattera 40 mg daily.
Objective
Allergies: No known drug allergies.
Substance Use Assessment: Denies use of tobacco, alcohol, or recreational drugs.
MSE:
- Appearance: Neatly dressed, good hygiene.
- Behavior: Slightly anxious, but cooperative.
- Speech: Normal rate, tone, and volume.
- Mood: Anxious.
- Affect: Appropriate to conversation.
- Thought Process: Organized, coherent.
- Thought Content: No evidence of delusions, paranoia, or hallucinations.
- Cognition: Fully oriented to person, place, and time.
- Insight/Judgment: Fair insight, judgment intact.
Physical Examination:
- General: Appears mildly anxious.
- HEENT: No visual abnormalities.
Assessment
- Diagnosis: ADHD, well-controlled.
Plan
- Continue Strattera 40 mg daily as prescribed.
- Follow-up in 3 months to reassess symptoms and response to medication.
Time spent: 30 minutes face-to-face.
Electronically signed by:
[Provider name, Credentials, Date signed]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Rationale and How the CPT Codes Were Selected:
Number and Complexity of Problems Addressed: Low, 1 stable chronic illnesses
Data Reviewed/Analyzed: none
Risk: Moderate: Moderate, prescription drug management
Rationale: The client displays Low number & complexity of problems with one stable chronic illness, No data reviewed, and Moderate risk for prescription management.
Level of MDM: Low
CPT Codes Selected: 99203
CPT code 99203 reimbursement rates
Reimbursement rates for sessions billed with 99203 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Billing and coding
How to use CPT code 99204
How to use CPT code 99204
Code 99204 represents a new patient appointment that’s at least 45 minutes in duration.
How to use CPT code 99204
Code 99204 represents a new patient appointment that’s at least 45 minutes in duration.