CPT code 99203: New patient visit2026 Medicare rate & RVUs

Medicare pays $117.57 for 99203 nationally in the office and $71.48 in a hospital or facility. Local office rates run $106.69–$146.95.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

Where 99203 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99203 rates by state

Office rate range in each state. Select a state to see its payment localities.

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.

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.

99203 compared with similar codes

How to choose

99202New patient visit

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 visit

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 visit

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.

99243Off/op cnsltj new/est low 30

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.

Codes related to 99203

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates