Reimbursement
$91.18
Threshold
20m
2026 Status
Active
What is CPT Code 99213?
CPT 99213 is defined as: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 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
1.3
Physician Effort
PE (Non-Fac)
1.34
Practice Expense
Malpractice
0.09
Risk Factor
Total RVU
2.73
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 synergy
G2211 is frequently added to 99213 for patients receiving longitudinal management of single or multiple conditions.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
selection criteria
Low MDM OR 20-29 minutes total time.
patient status
Established patient.
frequency
Once per encounter.
Compliance Checklist
Audit Defense
mdm low
Documentation should reflect management of at least 2 minor problems or 1 stable chronic condition.
2026 Update
2026 CMS policy continues to favor 99213 for high-volume primary care workflows.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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