What is CPT code 99213? Complete description, documentation requirements & billing guidelines. Learn when to use 99213 for office visits.

Understanding the Context

99213 CPT code description from the American Medical Association states: “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.” CPT Code 99213 Description The 99213 CPT code represents an office outpatient visit for an established patient service that requires moderate complexity documentation. CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care. What is CPT code 99213 used for? CPT code 99213 is used for an established patient office or outpatient evaluation and management visit when the service supports low medical decision-making or 20 to 29 minutes of total provider time on the date of the encounter.

CPT Code 99213 - Description and Fee Schedule 2026 | PayerPrice

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CPT Code 99213 - Description and Fee Schedule 2026 | PayerPrice
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Key Insights

CPT code 99213 represents an established patient office or other outpatient visit lasting between 20-29 minutes. This code is commonly used for office visits that require a moderate level of complexity and evaluation of the patient’s condition. The Current Procedural Terminology (CPT ®) code 99213 as maintained by American Medical Association, is a medical procedural code under the range - Established Patient. CPT code 99213 is one of the most frequently billed Evaluation and Management (E and M) codes in outpatient medicine. It represents a low level established patient visit, yet its financial and compliance impact is significant due to its high utilization across primary care and specialty practices.

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Final Thoughts

CPT Code 99213 is an Evaluation and Management (E/M) code for an established patient office or outpatient visit lasting 20-29 minutes or requiring low-level medical decision-making (MDM). What is CPT Code 99213? CPT 99213 is an established patient office or outpatient visit code. It’s used when a provider evaluates and manages a patient with a low to moderate level of medical decision making, or when the visit requires 20–29 minutes of total time spent on the date of service.