CPT code 99203: New patient visit, low MDM or 30 minutes2026 Medicare rate & RVUs in Maryland
Report 99203 for a new patient office or outpatient evaluation with low medical decision making or at least 30 minutes of practitioner time.
Medicare pays $118.37–$131.52 for 99203 in the office in Maryland, from Rest of Maryland to Washington, DC area. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99203 covers
A new patient has received no professional services from a physician or other qualified health care professional of the same specialty and subspecialty in the group during the preceding three years. Physicians, nurse practitioners, and physician assistants perform this office or outpatient evaluation in clinics and hospital outpatient departments. Presenting problems can include an uncomplicated acute illness or injury or a stable chronic condition, but the diagnosis alone does not establish low medical decision making (MDM). The clinician assesses the problem and develops a care plan.
Report 99203 when the visit meets low MDM or the physician's or qualified professional's total time on the encounter date reaches 30 minutes. MDM requires two of three elements at the low level: problems addressed, data reviewed and analyzed, and management risk. Count face-to-face and eligible non-face-to-face work, such as record review and documentation, but not clinical staff time or separately billed services. Record a medically appropriate history and examination when indicated; neither determines the level. If a minor procedure occurs that day, append modifier 25 only for a significant, separately identifiable E/M service beyond the usual procedure work.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Billing guides for 99203: G2211 add-on code
Where 99203 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$118.37 to $131.52
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $123.98 | $74.53 |
| Rest of Maryland | $118.37 | $71.73 |
| Washington, DC area | $131.52 | $77.23 |
How the 99203 rate is calculated
Each of 99203’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99203
RVUs × geographic indexes × conversion factor
Work1.60
1.60 RVUs× 1.000 GPCI
Practice expense1.76
1.76 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
3.5200
Conversion factor
$33.4009
Medicare rate
$117.57
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99203
99203 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate. Billing it with a same-day procedure? See modifier 25.
Place of service · 99203
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$117.57
- Non-facility (office)
- $117.57
- Facility
- $71.48
Higher because the practice carries its own overhead.
99203 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99202New patient visitStraightforward MDM or 15 minutes
- 99202 requires straightforward MDM or at least 15 minutes, such as a visit addressing one self-limited minor problem. Choose 99203 when low MDM is met or total time reaches 30 minutes.
- 99204Office visitNew patient, moderate complexity
- 99204 requires moderate MDM, supported by two of three MDM elements, or at least 45 minutes when selecting by time. Choose 99203 for low MDM or when its 30-minute threshold supports the time-based level.
- 99213Office visitEstablished patient, low complexity
- 99213 is an established-patient visit with low MDM or at least 20 minutes. Use 99203 only when the patient meets the new-patient definition and its MDM or time requirement.
- 99243Office consultationLow MDM, 30 minutes
- 99243 is an office consultation with low MDM or at least 30 minutes, used by payers that recognize consultation codes. Medicare uses 99203 for a qualifying new-patient visit at this level.
99203 billing questions
How many minutes support this visit when billing by time?
Physician or qualified health care professional time on the encounter date must total at least 30 minutes. Clinical staff time and work performed on a different date do not count.
Can this code be billed for a patient seen elsewhere in the group?
Yes, if no physician or other qualified health care professional of the same specialty and subspecialty in the group furnished professional services during the preceding three years. Otherwise, select an established-patient visit code appropriate to the service.
What should be reported for a Medicare consultation at this level?
Medicare does not recognize office consultation codes for payment. For a patient who meets the new-patient definition, report 99203 instead of 99243 when the visit meets low MDM or the 30-minute threshold.
Can G2211 be added to this visit?
Medicare allows G2211 with 99203 when the practitioner is the continuing focal point for the patient's care or provides ongoing care for a serious or complex condition. G2211 is generally not payable with modifier 25, with exceptions for certain Medicare preventive services and vaccine administration.
When is modifier 25 needed?
Append modifier 25 to 99203 when a significant, separately identifiable E/M service occurs on the same date as a procedure, such as a joint injection. The evaluation ordinarily needed to decide on and perform a minor procedure does not, by itself, support a separate visit.
99203 is in these specialty bundles: Primary care
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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