Reimbursement
$112.22
Threshold
30m
2026 Status
Active
What is CPT Code 99203?
CPT 99203 is defined as: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
This code is primarily used for E/M services. It falls under the category of Evaluation & Management and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.6
Physician Effort
PE (Non-Fac)
1.61
Practice Expense
Malpractice
0.15
Risk Factor
Total RVU
3.36
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (E/M service).
g2211 compatibility
Highly compatible with G2211 for longitudinal management.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
Low MDM OR 30-44 minutes total time.
patient status
New patient.
frequency
Once per encounter.
Compliance Checklist
Audit Defense
mdm clarification
Ensure documentation supports 'Low' complexity (e.g., 2+ minor problems or 1 stable chronic illness).
2026 Update
Medicare 2026 valuation maintains 99203 as a staple for initial primary care intake.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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