CPT 99203 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Office or Other Outpatient Services |
| Common Place of Service | • 11 - Office • 20 - Urgent Care Facility • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99203 by major payers:
$122.31
$120.29
$116.26
$163.37
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99203 | ||||||
United | 99203 | $140.41 | 1356784417 - MARY PHILIPS | 204923281 - MEMORIAL HERMANN MEDICAL GROUP | TX | Hospitalist Physician (208M00000X) |
United | 99203 | $82.01 | 1326218843 - LAURA REED | 850958357 - (OH) MERCY HEALTH PHYSICIANS SPRINGFIELD SPECIALTY CARE LLC | OH | Acute Care Nurse Practitioner (363LA2100X) |
United | 99203 | $165.42 | 1215005152 - SULAIMAN AZEEZ | 900603487 - (NY) PHYSICIAN AFFILIATE GROUP OF NEW YORK PC | NY | Gastroenterology Physician (207RG0100X) |
United | 99203 | $144.85 | 1699382580 - PAMELA RAINES | 850958357 - (OH) MERCY HEALTH PHYSICIANS SPRINGFIELD SPECIALTY CARE LLC | OH | Primary Care Nurse Practitioner (363LP2300X) |
United | 99203 | $126.23 | 1700886645 - MICHAEL KRUMHOLZ | 473829013 | NY | Gastroenterology Physician (207RG0100X) |
United | 99203 | $101.83 | 1811359177 - JUSTIN LEE | 351384201 - (IN) SOUTHERN INDIANA SURGERY, INC. | FL | Surgery Physician (208600000X) |
United | 99203 | $170.36 | 1902366313 - KELLY KIRK | 850958357 - (OH) MERCY HEALTH PHYSICIANS SPRINGFIELD SPECIALTY CARE LLC | OH | Obstetrics & Gynecology Physician (207V00000X) |
United | 99203 | $201.44 | 1518954726 - MITCHELL LOCKE | 135562308 - NEW YORK UNIVERSITY | NY | Gastroenterology Physician (207RG0100X) |
United | 99203 | $83.65 | 1114451143 - TRACY COPLEY | 850958357 - (OH) MERCY HEALTH PHYSICIANS SPRINGFIELD SPECIALTY CARE LLC | OH | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 99203 | $102.01 | 1871515304 - ROBERT HELFT | 611654232 - (NY) WESTERN NEW YORK MEDICAL PRACTICE PC | NY | Gastroenterology Physician (207RG0100X) |
United | 99203 | $297.79 | 1518042142 - CAROL RUMACK | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Diagnostic Ultrasound Physician (2085U0001X) |
United | 99203 | $115.61 | 1275730657 - RAHSAAN FRIEND | 261803679 - BLOOMINGTON MEDICAL SERVICES, LLC | OH | Gastroenterology Physician (207RG0100X) |
United | 99203 | $329.14 | 1538326301 - ROBERT BISHOP | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Critical Care Medicine Physician (2080P0203X) |
United | 99203 | $170.36 | 1851384671 - PETER FRIED | 850958357 - (OH) MERCY HEALTH PHYSICIANS SPRINGFIELD SPECIALTY CARE LLC | OH | Radiation Oncology Physician (2085R0001X) |
United | 99203 | $374.05 | 1639546435 - JESSICA HEIBEL | 752740653 - (TX) MAGELLA MEDICAL ASSOCIATES BILLING INC | TX | Pediatric Cardiology Physician (2080P0202X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 99203 vs. Other Office or Other Outpatient Services Codes
The CPT 99203 code is part of the Evaluation and Management services used for Office or Other Outpatient Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99203 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99202 | Low | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 15 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
| 99203 | Low | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand 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. (Desc Rvsd 1/1/2024) |
| 99204 | Moderate | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
| 99205 | High | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand High Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99203. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99203 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99203) and we'll show you how you compare in 15 minutes or less.
Medicare Reimbursement Lookup Tool
PayerPrice provides a free medicare lookup tool for physician fee schedule, drug ASP, MS-DRG weights, anesthesia conversion factors and other medicare related data.