How to use CPT code 99205
Code 99205 represents a new patient appointment that’s at least 60 minutes in duration.
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How to use E/M codes for evaluation and management services
How to use CPT code 99203
Billing and coding
How to use CPT code 99213
Code 99213 represents an existing patient appointment that’s at least 20 minutes in duration.
The 99213 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
CPT code 99213 description
Code 99213 represents an existing patient appointment that’s at least 20 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 99213 in the official CPT codebook:
CPT code 99213: Existing patient office visit, minimum 20 minutes
Office or other outpatient visit for the evaluation and management of an established 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, 20 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 20 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 99214 (moderate MDM), or 99215 (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.
99213 vs 99203: Existing patient vs. new patient
If you’re treating a new patient, you should use 99203 instead. A new patient is someone you have not seen in the last three years.
CPT code 99213 time frame
CPT code 99213 documentation
Documentation for 99213 is essentially the same as other E/M codes, but geared toward an existing patient.
- Problem-focused history: Document relevant information about the patient’s presenting complaint, medical history, and any other important factors.
- Problem-focused examination: Perform and document an evaluation that’s appropriate for the patient’s presenting complaint.
- Low complexity medical decision making: Make a judgment about the patient’s diagnosis, create a care plan, and prescribe appropriate treatments or interventions. You can find a full table of levels and elements of MDM here.
- If you are billing based on time, include start/stop timers.
In the example note below, the following factors are present, making 99213 the best code for billing the session:
- Number and complexity of problems addressed: Low - 1 stable chronic illness (MDD, recurrent)
- Data reviewed/analyzed: None
- Risk: Moderate - prescription drug management
Patient Name: Juan Gonzalez
Date of Service: 09/21/2024
Patient DOB: 05/08/1979
Appointment Time: 10:00 am - 10:30 am
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 30 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 his mental health.
Subjective
Chief Complaint: Follow-up consultation with a 45-year-old Hispanic patient diagnosed with recurrent major depressive disorder (MDD).
HPI:
Juan reports a stable mood over the past few months, with occasional dips in energy and motivation but no significant exacerbations of depressive symptoms. He describes difficulty with daily functioning but feels more in control of his emotions. He denies suicidal ideation or intent, maintains regular sleep patterns, and reports no changes in appetite.
Objective
ROS:
Constitutional: denies unexplained weight loss or weight gain, fever, night sweats
HEENT: denies
Cardiovascular: denies
Respiratory: denies
Neurological: denies
Psychiatric: depression
Gastro: denies
Musculoskeletal: denies
MSE:
Orientation: Alert & Oriented x3
Behavior: Cooperative, makes fair eye contact.
Appearance: neatly dressed, appears stated age
Speech: Normal
Perception: Normal
Thought content: logical
Insight/judgment: Normal
Cognition: Normal
Suicidality: Negative
Current Medications: Bupropion XL 150mg p.o. q.d.
Assessment:
Juan's depressive symptoms remain relatively stable. We discussed his current medication regimen. He expresses satisfaction with his current treatment plan and agrees to continue with regular follow-up appointments.
Dx: Recurrent major depressive disorder, stable F33.42
Plan:
- Continue with current medication Bupropion XL 150mg p.o. Q.d.
- Schedule follow-up appointment in one month
Electronically signed by:
[Provider Name, Credentials, Date]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
Rationale and How the CPT Codes Were Selected (based on 2/3 elements):
Number and Complexity of Problems Addressed: Low - 1 stable chronic illness (MDD, recurrent)
Data Reviewed/Analyzed: None.
Risk of Complications and/or Morbidity: Moderate - prescription drug management
Rationale: The client displays Low number and complexity of problems with 1 stable chronic illness, No data reviewed, Moderate risk addressed by prescription drug management
CPT Code Selected: 99213
CPT code 99213 reimbursement rates
Reimbursement rates for sessions billed with 99213 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 99205
How to use E/M codes for evaluation and management services
Within behavioral health, billing and documentation for E/M codes can sometimes be confusing.
How to use CPT code 99203
Code 99203 represents a new patient appointment that’s at least 30 minutes in duration.