What Is Billing Code 99213?

Billing code 99213 is a Current Procedural Terminology (CPT) code used by healthcare providers to report evaluation and management (E/M) services provided to established patients in an outpatient setting. This code is typically used for a moderate-level office visit that involves a focused medical history, physical exam, and medical decision-making.

To report CPT 99213 accurately, the healthcare provider must document specific elements of the visit, including the patient's medical history, the focused physical exam, and the medical decision-making process. The code is commonly used by primary care physicians, internists, and other healthcare providers who treat patients with stable medical conditions.

Insurance companies use CPT codes to determine reimbursement rates for healthcare services provided by healthcare providers. The reimbursement rate for CPT 99213 varies depending on the location, type of healthcare provider, and insurance carrier.