$69.33–$73.15
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.
On this page
CMS RVU26D · Effective 2026-10-01
99203 New patient visit Medicare reimbursement rates in Missouri
Report 99203 for a new patient office or outpatient evaluation with low medical decision making or at least 30 minutes of practitioner time. Compare 99203 office and facility rates across CMS payment localities in Missouri.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99203 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$109.32–$114.76
3 of 3 localities have a supported rate.
Facility setting
$69.59–$70.88
3 of 3 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 99203 pays more and less in Missouri
3 payment localities
$109.32 to $114.76
Evaluation and management
About 99203: New patient office visit, low complexity
Report 99203 for a new patient office or outpatient evaluation with low medical decision making or at least 30 minutes of practitioner time.
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.
Where the value comes from
- Work RVU1.60 · 45%
- Practice expense (office) RVU1.76 · 50%
- Malpractice RVU0.16 · 5%
8.7M
Medicare services in 2024 · #24 by national volume
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.
99203 compared with similar codes
Office rates for Missouri, from the same CMS release.
$165.77–$173.41
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.
$88.38–$92.86
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.
99243
No office rateOff/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.
Compare 99203 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
$113.86
Facility
$70.58
Metropolitan St. Louis →
Office / nonfacility
$114.76
Facility
$70.88
Rest Of Missouri →
Office / nonfacility
$109.32
Facility
$69.59
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
Primary care
Compare office and outpatient evaluation-and-management base rates.
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.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,00799195,,Phlebotomy,A,,0.00,2.89,,2.89,NA,0.05,2.94,2.94,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,00899199,,Unlisted special svc px/rprt,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,00999202,,Office o/p new sf 15 min,A,,0.93,1.25,,0.23,,0.07,2.25,1.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01099203,,Office o/p new low 30 min,A,,1.60,1.76,,0.38,,0.16,3.52,2.14,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01199204,,Office o/p new mod 45 min,A,,2.60,2.47,,0.66,,0.24,5.31,3.50,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01299205,,Office o/p new hi 60 min,A,,3.50,3.23,,0.94,,0.36,7.09,4.80,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01399211,,Off/op est may x req phy/qhp,A,,0.18,0.54,,0.04,,0.01,0.73,0.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00