CPT 99213
Office visit, established patient, level 3
A routine follow-up or problem visit with a doctor you have seen before, at low complexity: one stable chronic condition, or one new uncomplicated problem. It is the most commonly billed doctor's visit code in the United States.
Billed to Medicare
$189
What providers submitted, on average, for this code in an office.
Medicare accepted
$85
What Medicare treated as payable. Not a commercial rate or a cash price.
The gap
2.2x
How many times the accepted amount the billed figure was.
National averages from the Centers for Medicare & Medicaid Services, 2024 data, retrieved 2026-09-14. Medicare fee-for-service, physician and practitioner claims only. The hospital's own charge for the same code is separate and is usually higher. Based on 64,778,139.1 services.
Of the 4 doctor visits codes on this site with CMS figures, this one has the narrowest gap between billed and accepted. The widest is Initial hospital care, high complexity at 3.4x.
Where this line goes wrong
Time or decision making
Since 2021 office visit levels can be chosen by total time on the day or by medical decision making. Level 3 is 20 to 29 minutes of total time. A ten-minute visit billed at level 4 is the thing to question.
Facility fee in a hospital-owned clinic
If the practice is owned by a hospital, you may get a second charge for the clinic (G0463 or a revenue code) on top of the doctor's visit. That is why the same visit costs more after a practice is bought by a hospital.
A preventive visit that became a problem visit
An annual physical with a problem discussed can be billed as both the preventive code and a 99213 with a modifier. The second charge is legitimate only if the problem needed separate work.
Check it, then ask
- 1
Check the visit level against what happened and how long it took.
- 2
If there is a second facility charge, ask whether the practice is hospital-owned and whether you were told.
- 3
If a physical turned into a paid visit, ask what separate problem was addressed.
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People also ask
What is the difference between 99213 and 99214?
99214 requires moderate complexity, typically two or more chronic conditions, a new problem with an uncertain outcome, or a prescription drug decision, or 30 to 39 minutes of total time.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.