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CPT Code 99213 a Complete Guide
for (E/M) 2025

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

CPT Code 99213 is one of the most commonly used procedure codes for evaluation and management (E/M) services provided to established patients. Understanding the significant difference between correct use, reimbursement rates, and related codes such as 99212 and 99214 is required for accurate medical billing.

What is CPT Code 99213?

The 99213 CPT codes are used for an office or outpatient trip where a healthcare provider evaluates and manages an established patient. This code is usually used when the tour involves a low-complication medical decision-making process.

Process Code 99213 Description

According to the American Medical Association (AMA), Procedure Code 99213 requires at least two of the following three components:

An expanded problem-focused history
An expanded problem-focused examination
Medical decision-making of low complexity

Typically, the patient’s condition is of low to moderate severity, and the physician spends around 15 minutes in face-to-face interaction with the patient or their family.

99213 vs. Other CPT Codes

99212 vs. 99213

99212: Used for straightforward medical decision-making with a brief evaluation (around 10 minutes).
99213: Requires a slightly more detailed history and exam, with low complexity decision-making (around 15 minutes).

99213 vs. 99214

99214: Used when the evaluation involves a moderate complexity medical decision-making process and a longer visit duration (around 25 minutes).

99213 vs. 99215

99215: Reserved for cases with high complexity medical decision-making, often requiring around 40 minutes of face-to-face interaction.

99213 Reimbursement Rates for 2025

Reimbursement rates for CPT 99213 vary depending on the insurance provider, network status, and geographic location. Below are the estimated rates for 2025:

Medicare Reimbursement for 99213

CPT Code	Service Time	Reimbursement Rate
99212	10 minutes	$54.21
99213	15 minutes	$87.21
99214	25 minutes	$124.12
99215	40 minutes	$172.12

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Medicaid Reimbursement for 99213

CPT Code	Service Time	Reimbursement Rate
99212	10 minutes	$36.23
99213	15 minutes	$48.12
99214	25 minutes	$71.51
99215	40 minutes	$106.28

Commercial Insurance Reimbursement (Estimated by Medicare)

CPT Code	Service Time	Reimbursement Rate
99212	10 minutes	$92
99213	15 minutes	$94
99214	25 minutes	$96
99215	40 minutes	$152

Key Billing Tips for CPT Code 99213

Ensure Proper Documentation
- At least two of the three key components must be met to bill procedure code 99213.
- A detailed history, examination, and medical decision-making should be documented properly.
Use the Right Code for the Complexity Level
- If the treatment involves a more complex case, consider using 99214 instead.
- Overusing 99213 for higher-complexity cases can lead to claim denials.
Modifier Considerations
- If another procedure is performed during the same visit, a modifier 25 might be required to indicate a significant, separately identifiable E/M service.
Verify Payer Policies

Various insurance companies may have specific guidelines for 99213 CPT code reimbursements.
Some insurers may require additional documentation or pre-authorization.

Billing CPT Code 99213 general issues

Level 2 or level 3?

A general challenge in medical billing is determining whether the bill is to be 99212 or 99213 bills. If the journey involves a more detailed examination and making medical decisions is less complicated, then 99213 is the appropriate option.

Telehealth and 99213

With the rise of telehealth services, several providers billed CPT 99213 for virtual consultation. However, some insurers require a specific location (POS) code and modifications for telehealth claims. Always check the payment-specific rules to avoid denying.

Final thoughts

Using process code 99213 correctly ensures accurate reimbursement and compliance with insurance guidelines. By understanding the 99213 CPT code meaning, documentation requirements, and billing tips, healthcare providers can optimize their medical billing process.

Billing CPT 99213, 99214 for more guidance on time requirements, or insurance reimbursement strategies, contact medical billing services today!

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We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

At Cures Billing Services, we prioritize collaboration and recognize the uniqueness of each healthcare provider or organization
Maximize your revenue by focusing on growing your practice and let us handle all the back-end billing processes.
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Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.