At Billing Care Solutions, we help healthcare providers ensure accurate E/M coding to maximize reimbursement while maintaining full compliance. In this blog, we provide a complete 99213 CPT code description, along with billing requirements, time guidelines, and common mistakes to avoid.
99213 CPT Code Description
CPT code 99213 is used to report an office or other outpatient visit for the evaluation and management of an established patient that requires low medical decision making (MDM) or a qualifying amount of time spent on the date of the encounter.
Key Components of CPT Code 99213:
Established patient
Office or outpatient setting
Low complexity
Typically involves management of stable conditions
99213 CPT Code Billing Requirements (2021+ E/M Guidelines)
Under current CMS guidelines, CPT code 99213 may be selected based on either:
Medical Decision Making (MDM)
ORTotal time spent by the provider on the date of service
History and physical exam documentation should be medically appropriate, not level-driven.
Medical Decision Making for CPT Code 99213
To bill CPT code 99213 based on MDM, two of the following three elements must meet the low level:
1. Number and Complexity of Problems Addressed
Examples:
One stable, chronic illness
One acute, uncomplicated illness or injury (e.g., URI, minor sprain)
2. Amount and/or Complexity of Data Reviewed
Examples:
Reviewing a limited number of test results
Ordering basic labs or diagnostic tests
3. Risk of Complications and/or Morbidity
Examples:
Over-the-counter medication management
Minimal risk of morbidity from treatment
Time-Based Billing for CPT Code 99213
CPT code 99213 may also be billed based on total provider time on the date of the encounter.
Time Range:
⏱ 20–29 minutes
This includes:
Reviewing patient records
Performing the evaluation
Counseling and educating the patient
Ordering tests or medications
Documenting the encounter
Time does not include services that are separately billed.
CPT Code 99213 vs. 99214
Understanding the difference between these two commonly used codes is essential:
| CPT Code | Complexity | Time |
|---|---|---|
| 99213 | Low MDM | 20–29 minutes |
| 99214 | Moderate MDM | 30–39 minutes |
Billing 99214 instead of 99213 requires significantly more documentation and clinical complexity.
Common Specialties Using CPT Code 99213
CPT code 99213 is widely used in:
Family medicine
Internal medicine
Pediatrics
Dermatology
Cardiology
Endocrinology
Psychiatry
Because it reflects routine follow-up care, it is one of the most frequently billed E/M codes.
Common Billing Mistakes with CPT Code 99213
At Billing Care Solutions, we frequently identify these issues:
Under-documenting medical decision making
Overusing 99213 for very brief visits
Incorrect time documentation
Copy-and-paste notes without medical necessity
Inconsistent diagnosis-procedure linkage
Accurate documentation is essential to support reimbursement.
How Billing Care Solutions Can Help
Billing Care Solutions provides comprehensive medical billing and coding services, including:
E/M coding accuracy audits
Documentation improvement support
Denial management and appeals
Revenue cycle optimization
Specialty-specific billing solutions
Our experienced billing professionals ensure CPT code 99213 is used correctly and compliantly—every time.
Final Thoughts
The 99213 CPT code description reflects low-complexity care for established patients. When documented and billed correctly, it supports efficient reimbursement and compliance.
If your practice is experiencing E/M denials, downcoding, or audit concerns, Billing Care Solutions is here to help.
? Visit billingcaresolutions.com to learn more about our medical billing services and how we can improve your revenue cycle.
