Code 99213 represents an existing patient appointment that’s at least 20 minutes in duration.
December 9, 2024
11 min read
The 99213 code is an E/M code used by prescribing providers. For other E/M codes, visit this overview.
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 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.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
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.
Documentation for 99213 is essentially the same as other E/M codes, but geared toward an existing patient.
In the example note below, the following factors are present, making 99213 the best code for billing the session:
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.
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.
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.
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
Electronically signed by:
[Provider Name, Credentials, Date]
_____________________________________________________________________________________________
Rationale information is not required in your note; it is provided for educational purposes only.
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
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.
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
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Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
Headway strives to simplify billing insurance so you can focus on providing care. Read our comprehensive guide to mental health billing.
Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.
